Assessing and Managing Pain in the Elderly Lecture Powerpoint

Question 1

Consequences of chronic pain in the elderly (4)

Answer 1

• impaired ADL’s and ambulation
• depression
• accidents
• polypharmacy

Question 2

Barriers to treating pain in the elderly (3)

Answer 2

• difficulty of clinician to assess the pain
• atypical manifestations of pain
• underreporting by patients (believe it is normal)

Question 3

Chronic pain definition

Answer 3

Unpleasant sensory and emotional experience associated with actual or potential tissue damage who have pain for 3-6 months or more than expected

Question 4

Diagnosing pain in the elderly (4)

Answer 4

1) determine the type and cause of pain
2) identify exacerbating comorbidities
3) reviewing beliefs, attitudes, and expectations regarding pain
4) gather information that would assist and impact an individualized treatment plan (pain scales may be helpful but other cues may be necessary)

Question 5

Pain signature

Answer 5

Parameters affected by pain and the severity of their impact on the patient, particularly geriatric populations (does it keep you from grocery shopping, driving, hobbies, etc)

Question 6

Considerations for pain assessment in the cognitively impaired

Answer 6

• obtain a self report as possible with their ability
• investigate for possible pathologies that can produce pain
• observe for behaviors that indicate pain
• solicit a surrogate report from observer or caregiver
• consider analgesic trial to evaluate whether pain management results in reduction

Question 7

Physical exam for pain assessment in the elderly (3)

Answer 7

• vital signs
• Montreal cognitive assessment (Moca) or mini mental status
• musculoskeletal exam

Question 8

Most common conditions that may cause pain in the elderly (4)

Answer 8

• myofascial pain syndrome
• chronic low back pain
• lumbar spinal stenosis
• fibromyalgia

Question 9

Pharmacodynamic vs pharmacokinetic

Answer 9

What the drug does the body vs what the body does to the drug

Question 10

Drug sensitivity changes in the elderly (3)

Answer 10

• benzos response is increased
• response to warfarin is increased
• B1 and 2 receptor responsiveness decreased

Question 11

Older adults have ___ body fat and ___ water and muscle mass. Water soluble drugs become more ___ and fat soluble drugs have ___ half lives

Answer 11

increased, decreased, concentrated, longer

Question 12

Liver metabolism changes with normal aging (3)

Answer 12

• oxidation variable and may decrease resulting in prolonged drug half life
• conjugation usually preserved
• 1st pass effect unchanged

Question 13

Renal excretion changes with normal aging (1)

Answer 13

-GFR rate decreases with advancing age resulting in decreased excretion

Question 14

Nociceptive pain vs neuropathic pain

Answer 14

Nociceptive is either visceral (internal) or somatic (muscles and skin) due to stimulation of pain receptors resulting typically from injury or arthritis and is treated with both opioid and nonopioid agents, vs neuropathic is disturbance of either peripheral or central nervous system resulting in dysethesias and is treated with adjuvant agents such as anticonvulsants or antidepressants

Question 15

Step therapy for pain management in geriatrics (3)

Answer 15

• Nonpharmcologic treatments
• topical and injected analgesics (diclofenac, capsaicin, lidocaine)
• systemic pharmacologic agents (acetaminophen, salsalate, ketorolac, oxycodone, morphine, oxymorphine)

Question 16

Opioid side effects (5)

Answer 16

• mental status changes
• constipation
• balance issues
• dry mouth
• nausea

Question 17

Rate of addiction in older patients with no current or past history of substance abuse

Answer 17

low

Question 18

Analgesia ladder

Answer 18

• acetaminophen
• NSAIDs
• Codeine, hydrocodeine in combo with acetaminophen
• morphine, hydromorphine, fentanyl

Question 19

Pallliative care

Answer 19

Combination of physical, spiritual, and psychological approaches providing relief from symptoms and stress of illness with goal being to improve quality of life for patient or family, occurs ALONGSIDE treatment (unlike hospice when we stop treatment and just alleviate pain to impending death), will not hasten death!!!