pain control in the elderly
TRANSCRIPT
Pain in the Elderly Assoc. Prof. Brendan Moore
University of Queensland
Pain Medicine Specialist Brisbane Private Hospital and Greenslopes Private Hospital
Prevalence of Persistent Pain
• Prevalence is 17 % for males and 20% for females
• Prevalence increases with increasing age • Peaks at 27% for males aged 65 – 69 yrs • Peaks at 31% for females aged 80 – 84yrs
Blyth FM et al Pain 2001;89:127-‐134
Mul5ple Causes of Pain in Elderly
• Ageing does not cause pain • MulRple pathologies increase with age,
some of which may be painful • May have mulRple causes of pain • New symptoms require proper evaluaRon
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002
Does Sensi5vity to Pain change with age?
Discussion Point
Pain Sensi5vity may differ with Increasing Age • Elderly may have higher thresholds to Pain • The Elderly may experience less Pain at
lower levels of sRmulaRon • But once felt as pain, the sensaRon is no
different from younger people
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002
Can people with Demen5a accurately
report Pain?
Discussion Point
Demen5a and Repor5ng of Pain • Able to report current pain • Past pain reports less accurately reported • As demenRa increases, ability to report
pain decreases • As communicaRon fails, importance of
observaRon increases
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002 McClean WJ. Nursing & ResidenRal Care 2003:5(9) 428-‐430
Influence of Cogni5on
People with demenRa are more likely to have pain that is not treated
ContribuRng factors: • Less likely to volunteer informaRon • Less likely to complain about pain
McClean WJ. Nursing & ResidenRal Care 2003:5(9) 428-‐430
Degenera5ve Lumbar Back Pain
Assessing Back Pain
• Is the pain mechanical? • Are there neurological features? • Is there correlaRng leg pain? • Are further invesRgaRons required?
Pharmacological Treatment of Pain
In the Elderly
Special Considera5ons in the Elderly
• MulRple sources of Pain • ComorbidiRes and polypharmacy • Reduced effecRve renal funcRon • Reduced muscle mass, increased adipose • Increased drug sensiRvity
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002 NaRonal Prescribing Service. Drug use in the elderly. PPR26 July 2004
Opioids
Opioid Trial Guidelines • Use low dose, sustained release opioid Start Low and Go Slow
for paRents who are: • Elderly • Taking other CNS depressants • Opioid naïve • Have hepaRc or renal insufficiency
Opioid Dose Equivalence
MAXIMUM Opioid Dose Guide
Principles of Good Prescribing in the Elderly • Prescribe lowest effecRve dose • Small number of medicaRons • Simple dose regime • Simple verbal and wrihen instrucRons
NaRonal Prescribing Service. Drug use in the elderly. PPR26 July 2004
“Pain is not a normal part of aging
and should be evaluated as in any other age group”
Pain the Fi/h Vital Sign
American Pain Society Mashford et al. TherapeuRc Guidelines: Ed 4. 2002
Thank you