Table 3 Summary of findings from stakeholders

• Findings suggested that care managers grappled with the complexities of managing pain, but were keen to know how to better manage pain for their residents

• Those care homes using a tool were using the Abbey Pain Scale, albeit with some reluctance

• Mangers and staff felt there was a lack of consistency, with no clear pathway for the systematic assessment and management of pain

• Staff were reluctant to use pain assessment tools, and their use was therefore limited. They found them complex to use.

• For residents with dementia, challenging behaviour appeared to be more attributed to the condition, rather than the possibility of the presence of pain

• While a wide variety of pain medication was used (e.g. non-opioids, anti-inflammatories, and opioids), there was still some expressed concern about over-dosage

• Non-pharmacological interventions were used, but only to a limited extent, and not at all in some care homes

• The majority of staff had received no training in relation to the assessment and management of pain

• A desire to improve was expressed by most managers and it appeared that both internal and external contexts needed to be strengthened to achieve this.