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PAIN MANAGEMENT IN ELDERLY PERSONS

Physicians Have a Moral Obligation to Provide Comfort and Pain Management Especialy for those near the end of life!. Pain is the most feared complication of illnessPain is the second leading complaint in physicians' officesOften under-diagnosed and under-treatedEffects on mood, functional status,

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PAIN MANAGEMENT IN ELDERLY PERSONS

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    1. PAIN MANAGEMENT IN ELDERLY PERSONS UCLA Multicampus Program of Geriatrics and Gerontology

    2. Physicians Have a Moral Obligation to Provide Comfort and Pain Management Especialy for those near the end of life! Pain is the most feared complication of illness Pain is the second leading complaint in physicians’ offices Often under-diagnosed and under-treated Effects on mood, functional status, and quality of life Associated with increased health service use

    3. 18% of Elderly Persons Take Analgesic Medications Regularly (daily or more than 3 times a week) 71 % take prescription analgesics 63% for more than 6 months 72% take OTC analgesics Median duration more than 5 years 26% report side-effects 10% were hospitalized 41% take medications for side-effects

    4. ELDERLY PATIENTS TAKING PAIN MEDICATIONS FOR CHRONIC PAIN WHO HAD SEEN A DOCTOR IN THE PAST YEAR 79% had seen a primary care physician 17% had seen a orthopedist 9% had seen a rheumatologist 6% had seen a neurologist 5% had seen a pain specialist 5% had seen a chiropractor 20% had seen more than 5 doctors

    5. Common Causes of Pain In Elderly Persons Osteoarthritis back, knee, hip Night-time leg cramps Claudication Neuropathies idiopathic, traumatic, diabetic, herpetic Cancer

    6. MISCONCEPTIONS ABOUT PAIN Myth: Pain is expected with aging. Fact: Pain is not normal with aging.

    7. PAIN THRESHOLD WITH AGING

    8. Age Related Differences in Sensory Receptor Function Encapsulated end organs 50% reduction in Pacini’s 10-30% reduction Meissner’s/Merkels Disks Free nerve endings no age change

    11. MISCONCEPTIONS ABOUT PAIN Myth: If they don’t complain, they don’t have pain Fact: There are many reasons patients may be reluctant to complain, despite pain that significantly effects their functional status and mood.

    12. REASONS PATIENTS MAY NOT REPORT PAIN Fear of diagnostic tests Fear of medications Fear meaning of pain Perceive physicians and nurses too busy Complaining may effect quality of care Believe nothing can or will be done

    15. There is a lot we can do to relieve pain! Analgesic drugs Non-drug strategies Specialized pain treatment centers Patient and caregiver education and support

    16. Analgesic Drugs Acetaminophen NSAIDs Non-selective COX inhibitors Selective COX-2 inhibitors Opioids Others Antidepressants Anticonvulsants Substance P inhibitors NMDA inhibitors Others

    17. CAUTION Meperidine (Demerol) Butorphanol (Stadol) Pentazocine (Talwin) Propoxiphene (Darvon) Methadone (Dolophine) Transderm Fentanyl (Duragesic)

    18. Do Not Use Placebos! Unethical in clinical practice They don’t work Not helpful in diagnosis Effect is short lived Destroys trust

    19. Non-Drug Strategies Exercise PT, OT, stretching, strengthening general conditioning Physical methods ice, heat, massage Cognitive-behavioral therapy Chiropracty Acupuncture TENS Alternative therapies relaxation, imagery herbals

    20. PATIENT AND CAREGIVER EDUCATION Diagnosis, prognosis, natural history of underlying disease Communication and assessment of pain Explanation of drug strategies Management of potential side-effects Explanation of non-drug strategies

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