Pain Management in Skilled Nursing Facilities Under PDPM

Pain is one of the most common and under-addressed barriers to delivering high-quality care in skilled nursing facilities (SNFs). When pain is uncontrolled, residents are less able to participate in therapy and rehabilitation, leading to poorer functional recovery and a lower quality of life.

Today’s reimbursement landscape, including the patient-driven payment model (PDPM) and value-based care initiatives, requires SNFs to prioritize pain management strategies that go beyond quick fixes. The focus must be on coordinating care, tracking real-world outcomes and ensuring safe, effective prescribing.

A physician-led, interdisciplinary, and evidence-based approach, like Medrina’s physiatry partnership, can support better pain management under PDPM and help your SNF exceed compliance requirements — improving resident satisfaction and operational performance.

3 Reasons Pain Management Matters in SNFs Under PDPM and Value-Based Care

In today’s skilled nursing environment, pain management is more than another clinical task. This specialized approach to diagnosing and treating acute or chronic discomfort runs through every aspect of resident care and recovery.

As the healthcare system increasingly shifts toward PDPM and value-based outcomes, there are numerous reasons effective pain management should be a leadership priority central to your SNF’s mission of delivering compassionate, high-quality care.

1. Overcoming Pain as a Barrier to Therapy Participation

Therapy is often the cornerstone of post-acute recovery—but different types of pain can stand in the way, including:

• Post-surgical orthopedic pain
• Post-stroke spasticity
• Joint pain
• Chronic low back pain
• Neuropathic pain

Whether recovering from a knee replacement or a stroke, early recognition and proactive management of pain helps residents better tolerate therapy, fueling functional recovery. Yet, this requires shifting your SNF's focus from numbing or masking pain to a comprehensive approach that addresses the overall rehabilitation journey.

2. Addressing Pain Management as a Quality and Outcome Issue

When pain goes unchecked, residents are more likely to struggle with mobility and self-care, potentially undermining hard-won functional gains. In the era of PDPM and value-based care, where measurable clinical outcomes are key, resident-centered pain management is more important than ever. This approach sets the stage for optimal patient recovery — with progress residents can feel and your team can track.

3. Meeting Regulatory Expectations Around Pain Management

Regulatory standards have evolved alongside care models. The Centers for Medicare & Medicaid Services (CMS) expects SNFs to consistently assess, document and manage pain throughout a resident’s stay. This process includes structured, ongoing pain assessments and regular involvement of physicians in care planning. Reliance on reactive approaches often falls short.

Strong oversight keeps your program aligned with best practices and ongoing CMS compliance.

The Role of Physiatrist-Led Oversight in PDPM Pain Management

Not all pain is the same or responds to the same treatment. Physiatrists, or physical medicine and rehabilitation (PM&R) physicians, are experts in pain management and bring specialized skills that help every discipline in the nursing facility contribute to better outcomes.

Complex, Functional Pain Expertise

Physiatrists bring a unique depth of training, especially valuable to SNFs, providing both clinical direction and hands-on patient care. They are specialists in:

• Functional and musculoskeletal pain: Addressing the aches, joint discomfort and movement limitations that impact daily living
• Neurologic and post-stroke pain syndromes: Ensuring better management for residents recovering from brain injuries or strokes
• Pain conditions that directly hinder mobility: Aligning their approach with rehabilitation-focused care goals, especially activities of daily living

Comprehensive Pain Evaluations

A strong pain management plan starts with a precise physician evaluation. Physiatrists are trained to:

• Distinguish between nociceptive pain resulting from direct body injury and neuropathic pain stemming from the nervous system.
• Recognize patterns that require tailored treatments.
• Identify less obvious contributors such as spasticity, contractures or centralized pain.
• Observe how discomfort interferes with a resident’s participation in physical or occupational therapy.

A thorough pain evaluation directly after admission means the right interventions are in place from the start, supporting safety, engagement and functional recovery.

Ongoing Reassessment

The experience of pain at SNFs is rarely static. It evolves through the process of initial management, therapy and recovery. Physiatrists structure scheduled reassessments, ensuring pain management strategies adapt as residents regain function or experience new challenges.

Interdisciplinary Coordination

Physiatrists are leaders, bridging the contributions of physicians, therapy staff and nursing to create a true interdisciplinary approach. With regular oversight and clear communication, PM&R specialists help the entire care team proactively adjust treatments, keeping the focus on patient progress rather than on symptom management alone.

Skilled Nursing Facility Pain Management Services: Evidence-Based, Non-Opioid–Focused Approaches

Today’s post-acute pain management is about more than easing discomfort. It means restoring function while protecting residents by minimizing the risks that come with opioid medications. Medrina's physician-led pain programs use evidence-based strategies to manage pain effectively while keeping each resident’s goals at the center of care.

Judicious Opioid Prescribing

For many older adults and individuals needing rehabilitative care, opioids introduce as many problems as they solve. Risks such as falls, sedation, delirium and constipation can quickly derail the recovery process and hinder resident participation in therapy.

Thoughtful, physician-led prescribing is essential. Opioids are reserved for situations where alternative options have failed, and they are used at the lowest effective dose, with close monitoring.

Multimodal Medications

An effective pain management plan rarely relies on a single medication. Instead, SNFs can utilize two or more different classes of pain medications or interventions to maximize pain relief while reducing reliance on opioids, such as acetaminophen and topical agents when appropriate. For residents experiencing neuropathic pain or spasticity, physicians may selectively introduce targeted medications to address those specific needs.

Clinical oversight ensures these drugs are thoughtfully integrated into a care plan, helping to avoid the pitfalls of polypharmacy or adverse interactions while optimizing pain control and function.

Therapy-Aligned Interventions

Pain relief in the SNF setting extends beyond medications. By teaching residents functional pain management skills, care teams empower individuals to stay active and independent, even when managing chronic or fluctuating pain. These strategies may include:

• Adaptive positioning
• Custom equipment
• Physical and occupational therapy interventions
• Activity pacing
• Energy conservation

How to Integrate Pain Management With Therapy and the Care Team

Pain management is most successful when it’s woven into each resident’s rehabilitation journey. Physician-led integration, such as the PM&R services provided by Medrina, creates the right conditions for routine collaboration, so therapies and treatments drive better, more measurable outcomes for your residents.

This integrative approach may look like:

• Building pain strategies around functional goals: Physiatrists guide pain treatment to directly support a resident’s ability to move, walk or complete daily self-care tasks. For example, thoughtful medication timing and intervention can make it easier for a post-hip-replacement resident to participate in therapy and work on walking independently.
• Updating pain management plans as recovery progresses: The care team regularly reviews pain levels, therapy tolerance and new challenges, adjusting interventions to support continued gains without unnecessary medications.
• Holding interdisciplinary care plan discussions: Routine meetings of nurses, therapists, and physicians to share updates and coordinate approaches keep everyone focused on both pain control and rehabilitation milestones.
• Maintaining shared documentation: Centralized records allow teams to track pain assessments and treatment adjustments in real time, so nothing gets missed.

Physiatrist-Led Pain Management That Elevates Value-Based Care in Skilled Nursing Facilities

As value-based care and PDPM continue to drive change in post-acute settings, targeted pain management strategies are essential for delivering safe, effective and resident-centered results.

Medrina empowers skilled nursing facilities to meet and exceed expectations through a structured, physician-led pain management program that brings together the entire care team and keeps outcomes at the forefront.

This approach is built on several pillars:

• Driving functional outcomes: Medrina PM&R specialists focus on measurably improving mobility, independence and quality of life. Whether supporting post-surgical recovery, stroke rehab or chronic condition management, this leadership focus keeps pain management directly tied to each resident’s functional goals and therapy participation.
• Enhancing regulatory alignment: With Medrina, SNFs benefit from patient progress aligned with CMS quality initiatives and national best-practice standards, ensuring thorough documentation, regular pain reassessment and survey-ready compliance.
• Integrating seamlessly with SNF teams: Medrina physiatrists communicate closely with nursing and therapy teams, adapting care plans as residents progress in recovery. This interdisciplinary coordination drives outcomes and supports staff education and collaboration, creating a culture of proactive, evidence-based care.
• Providing flexibility across facilities: Medrina’s consistent clinical standards never come at the expense of flexibility. Each facility receives a tailored approach, built to address your unique resident needs.

Contact Medrina to Achieve High-Quality Pain Management in Your SNF

Don’t settle for standard approaches to post-acute pain. With Medrina, you can advance pain management, boost resident outcomes and bring true value-based care to your skilled nursing facility.

Contact us today to discover how our physician-led pain solutions can support your team and your residents.

Content Reviewed By: Matthew Cowling, D.O.
Chief Clinical Officer

Dr. Cowling is Board Certified in Physical Medicine and Rehabilitation, with a specialized focus on Subacute Rehab, Orthotics and Prosthetics, and the non-surgical management of Musculoskeletal Injuries. He graduated from Michigan State University College of Osteopathic Medicine and completed his residency and specialty training in PM&R at the University of Wisconsin.

Dr. Cowling has a deep passion for teaching and advancing the field of Physiatry in post-acute care. As Chief Clinical Officer at Medrina, he works to spearhead the advancement of physician protocols, education, and communication within the clinical team.