Pain Management in the Elderly Flashcards
Barriers to recognition of pain
No objective biological markers for the presence of pain
Blunted response
Cognitive & communication
Cultural & social
Co-morbidities/multiple meds
Staff training & access to tools
System barriers
Factors associated with the development of chronic pain in elderly people
Degenerative joint disease
Rheumatoid arthritis
Low back disorders
Crystal-induced arthropathies
Osteoporosis with recurrent vertebral body compression fractures
Neuropathic pain
Headaches
Oral or dental pathology
Chronic leg cramps
PVD
Post-stroke syndromes
Improper positioning, use of restraints
Immobility, contractures
Pressure ulcers
Amputations
Non-pharm management of pain
Physical activity
Patient education
Cognitive behavioral therapies
Adjuncts
For persistent pain
Prescribe persistent analgesia, take routinely
Acetaminophen
Useful for mild to moderate pain
Caution in hepatic failure, EtOH use, warfarin
NSAIDs & Cox II
Useful for mild to moderate pain
Musculoskeletal pain
Diclofenac is a topical option
Absolute CI: PUD, CKD, HF
Duloxetine
Chronic musculoskeletal pain
Neuropathic pain
First line:
Alpha-2 ligands (pregabalin, gabapentin)
SNRIs
Second line:
Lidocaine
Capsaicin
Side effects of opioids
Respiratory depression
Lethargy/sedation
Miosis
Toxicity from opioids
Severe respiratory depression, apnea
Decrease LOC, unarousable
Pinpoint pupils, fixed
Preferred opioids in elderly
Morphine
Hydrocodone
Oxycodone
Hydromorphone
Fentanyl
CDC guidelines for treatment of pain
Not applicable to sickle cell disease, cancer-related pain, palliative care or end-of-life care
Determine whether or not to initiate opioids for pain
Selecting opioids and determining opioid dosages
Deciding duration of initial opioid prescription and conducting follow-up
Assessing risk and addressing potential harms of opioid use
