geriatric pain management

Acute pain is the bodys normal response to noxious stimuli. Physicians psychologists psychiatrists and physical therapists work together to develop pain management strategies based on their individual evaluations of the patients.

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The maximum daily dosage of acetaminophen allowed is 4 g with dose adjustments up to 50-70 required in patients with hepatic dysfunction.

. Unfortunately due to difficulties in assessing pain in geriatric patients the complexities of multiple comorbidities and the high prevalence of polypharmacy many practitioners are reluctant to treat pain aggressively in this unique patient population. Geriatric pain assessment requires a comprehensive and multidisciplinary approach to the description diagnosis and management of chronic pain. Geriatric Pain Management.

11 acetaminophen 325-650 mg orally recommended maximum 3 g per day is considered a safe initial treatment for common mild to moderate pain ailments such as osteoarthritis and low back pain. Previous chapter Next chapter. Helping to Identify and Manage Patients Pain Engaging patients in their own pain management According to the NIH a majority of elderly persons today have significant pain problems that go undertreated.

8 The World Health Organization has advocated the use of opioids as part of three-step ladder in treating pain starting with simple analgesics like acetaminophen and if pain is uncontrolled adding weak. This site is dedicated to providing quality resources and tools for quality pain care for older adults. Relaxation Relaxation as a Nondrug Pain Treatment provides a general overview of the use of positioning to assist with pain control including the benefits of relaxation and relaxation techniques.

However use of the information provided remains the responsibility of the individual clinician. Drug Related Interventions Bowel Management for Opioid Use. Headaches lower back pain Drowsiness dizziness dry mouth constipation Topical Capsaicin Cream MentholMethyl Salicylate Cream Bengay Lidoderm 5 Patch all work for shorter period of time Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.

She is also taking Naproxen 220 mg four to five tablets a day over-the-counter and Ibuprofen 200 mgabout 8 tablets a day. Health care providers should use their clinical judgment in each situation and consider factors such as the patients age medical condition and the benefits versus risks of a suggested treatment. Pain Management Planning and implementing an effective plan of care for pain in older adults requires knowledge and interdisciplinary team involvement.

These include tertiary TCAs amitriptyline imipramine clomipramine and doxepin and two muscle relaxants cyclobenzaprine and orphenadrine. Nevertheless on account of existing comorbidity polypharmacy as well as of impaired organ function the pharmacological pain therapy in old patients also poses a potential hazard. Ice may also help prevent tissue damage.

American Geriatrics Society AGS recommends acetaminophen as the first-line agent for mild to moderate chronic pain in the elderly 1 due to its favorable safety profile. Behaviors that fall under the term pseudoaddiction include those behaviors in which older adults with unrelieved pain become focused on obtaining medications start clock watching or otherwise seem. Pain Interventions Linked to Self-Reports When Treating Geriatric Patients Further the team found that nonpharmacological interventions eg position change cold application were documented for only 12 of the patients.

Geriatric Pain Management and Special Considerations General Principles. Resources in this section include terminology key principles for pain management and tools for documenting and communicating pain treatments and response to treatment. Development of abuse-like behaviors that are driven by desperation surrounding unrelieved pain and are eliminated by effective pain management.

The use of opioids for treatment in the elderly has increased within the past few years due to adverse gastrointestinal and cardiovascular complications associated with NSAIDS. Although pain prevalence is higher with geriatric than with younger patients. This review will assess the evidence basis for medications used for spine-related pain in older adults with a focus on drug metabolism and adverse.

The November issue of Practical Pain Management highlighted the positive benefits of incorporating an exercise program even light exercise into a pain management program for elderly patients³⁴ The benefits include improving physical function reducing isolation and depression and enhancing balance and mental acuity. It is relatively simple to implement and consists of NSAIDs muscle relaxants opioids and other adjuvant therapy. Use an ice pack or put crushed ice in a plastic bag.

While medications play an important role in pain management their use has limitations in geriatric patients due to reduced liver and renal function comorbid medical problems and polypharmacy. There are unique considerations to selecting medications in older adults including changes in pharmacokinetics pharmacodynamics polypharmacy and likelihood of side effects. Acute pain typically lasts for days to weeks but it may last for months during the healing process.

Cover it with a towel and place it on the area for 15 to 20 minutes every hour or as directed. 12 Because pain is a highly subjective experience it is important for a thorough assessment to be conducted to determine the cause of pain and the most appropriate course of treatment. Prescribing these medications is not without risks however.

Drug treatment is generally the first and most widely used treatment modality to control geriatric pain. Pain management in the elderly should involve a multidisciplinary approach including multimodal medications selected interventions physical therapy and rehabilitation and psychological treatments. Pain will always be one of the most pervasive and elusive issues to treat in patients especially for the elderly.

This chapter provides an overview of geriatric pain management strategies including thoughtful assessment focus on function and quality of life judicious use of pharmacologic and nonpharmacologic interventions monitoring for response and adherence and adjustment to individual patient andor caregiver needs. Ice helps decrease swelling and pain. Acetaminophen aka paracetamol is the recommended first-line therapy among older adults for mild to moderate pain by the american geriatric society ags.

These facts shows the relevance of a sufficient pain therapy in geriatric patients. Safe and effective treatment therefore requires a working knowledge of the physiologic changes associated with aging the. The authors did point out however that this does not necessarily mean none were offered.

Safe and effective pain management in the older population requires an understanding of individual patient-centered factors such as comorbidities risks of polypharmacy potential drug-disease interactions motivation for treatment adherence financial burden and expectations. Her medications include Norvasc Aspirin Metoprolol multiple inhalers Lovastatin Omeprazole Morphine Sulphate ER 60 mg q6h ATC Oxycodone 10 mg qid prn pain and Cymbalta 20 mg qd. Exercise can help improve movement and strength and decrease pain.

Here clinicians patients and family caregivers have access to free evidence-based pain assessment tools pain management strategies and resources to help identify and manage pain in older adults including quality improvement processes focused on. The Beers List Table 7 also focuses on pain medications that should be avoided or have dosage reduced with varying levels of kidney function in older adults.

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