Pearls and Pitfalls of Pain Management in Older Adults

you-are-leaving-pain-300x300Pain is the number one reason why people seek care in the Emergency Department (ED). One major goal of acute care is diagnosing the cause of the pain, but another is helping relieve the suffering associated with pain. In older adults, some of the risks of pain management with opioids are amplified, such as the risk of sedation and falls. With NSAIDs, there is a higher risk of acute renal insufficiency and electrolyte abnormalities, as well as cardiovascular risks with longer treatment. How should we approach acute pain management in the ED, and on discharge in older patients? In this podcast episode, Tim Platts-Mills, an expert and researcher on pain in older adults talks us through some ideas for non-opiates, opiates, and other adjuncts. We discuss some of the risks of over-treatment and under-treatment, and introduce the idea of the allostatic load created by chronic pain.

Selected References

  1. Hwang U, Platts-Mills TF. Acute pain management in older adults in the emergency department. Clin Geriatr Med. 2013;29(1):151-164. http://www.ncbi.nlm.nih.gov/pubmed/23177605
  2. Platts-Mills TF, Esserman DA, Brown DL, Bortsov AV, Sloane PD, McLean SA. Older US emergency department patients are less likely to receive pain medication than younger patients: Results from a national survey. Ann Emerg Med. 2012;60(2):199-206. http://www.ncbi.nlm.nih.gov/pubmed/22032803
  3. Hwang U, Richardson LD, Harris B, Morrison RS. The quality of emergency department pain care for older adult patients. J Am Geriatr Soc. 2010;58(11):2122-2128. http://www.ncbi.nlm.nih.gov/pubmed/21054293
  4. Terrell KM, Hui SL, Castelluccio P, Kroenke K, McGrath RB, Miller DK. Analgesic prescribing for patients who are discharged from an emergency department. Pain Med. 2010;11(7):1072-1077. http://www.ncbi.nlm.nih.gov/pubmed/20642733
  5. Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352(13):1324-1334. http://www.ncbi.nlm.nih.gov/pubmed/15800228
  6. Siddall PJ, Cousins MJ. Persistent pain as a disease entity: Implications for clinical management. Anesth Analg. 2004;99(2):510-20, table of contents. http://www.ncbi.nlm.nih.gov/pubmed/15271732
  7. Jakobsson U, Klevsgard R, Westergren A, Hallberg IR. Old people in pain: A comparative study. J Pain Symptom Manage. 2003;26(1):625-636. http://www.ncbi.nlm.nih.gov/pubmed/12850645
  8. Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet. 1999;354(9186):1248-1252. http://www.ncbi.nlm.nih.gov/pubmed/10520633
  9. Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE study group. systematic assessment of geriatric drug use via epidemiology. JAMA. 1998;279(23):1877-1882. http://www.ncbi.nlm.nih.gov/pubmed/9634258

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