Geriatrics - Pain Management Flashcards
Pain - Mechanisms
nociceptive
neuropathic
visceral or somatic
Pain Assessment (PQRST)
palliative / provocative
quality
radiation
severity
temporal (timing)
Nonspecific Signs Suggestive of Pain
frowning, grimacing, clenched teeth
fidgeting, restlessness
agitation
eating and / or sleeping poorly
crying, groaning, heavily breathing
decreased activity levels
resisting certain movements
change in gait or behavior
loss of function
Non-Pharmacological Pain Management
physical activity
CBT
heat / cold
massage
acupuncture
spirituality
Mild Pain - First-Line Treatment
acetaminophen and / or NSAIDs
Moderate Pain - First-Line Treatment
(Second-Line for Mild Pain)
combination opioid and acetaminophen or NSAIDs
consider NSAIDs around the clock and opioid as needed
Severe Pain - First-Line Treatment
opioids carefully titrated to effect
avoid excessive sedation
NSAIDs - Absolute CIs
PUD
CKD
HF
Neuropathic Pain - First-Line Treatment Options
alpha-2 delta ligands (gabapentin, pregabalin)
SNRIs (duloxetine)
TCAs (avoid tertiary)
Neuropathic Pain - Second-Line Treatment Options
topical agents (lidocaine, capsaicin)
Opioid Therapy - Indications
all patients with moderate-severe pain, pain-related functional impairment, or diminished quality of life
Opioid Analgesics - Preferred Options for Elders
morphine
hydrocodone
oxycodone
hydromorphone
fentanyl
Opioid-Induced Nausea - Management
haloperidol
chlorpromazine
meclizine
ondansetron
metoclopramide
lorazepam
Opioid-Induced Constipation - Management
senna, bisacodyl
docusate
PEG
magnesium citrate
naloxegol
Pain - Steroid Indications
patients with pain-associated inflammatory disorders or metastatic bone pain
