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• An unpleasant sensory or emotional experience
associated with actual or potential tissue damage
• The World Health Organization (WHO) has stated
that pain is one of the most underestimated
healthcare problems in the world…
•Reduced quality of life
•Decreased appetite, poor nutrition
•Impaired sleep
•Mood disorders, particularly depression
•Diminished function
•Reduced cognitive performance
•Risk of disability, inability to perform ordinary
activities
•May be a form of “elder abuse”!
Experts in geriatrics, pain management and
medication safety
Represented many parts of healthcare
–academia, government, health care
plans, consumer advocacy
•Discussed challenges to optimal use of pain
medications in older adults
•Task: Identify area(s) of focus for safe use activities
Challenges
Failure to effectively
use available
procedures and
processes
Lack of patient
education and
awareness
Insufficient
training of health
providers
Failure to engage,
educate, and
communicate with
relevant stakeholders
General Approach To Assessment
And Treatment
Optimal clinical
outcome
3 general
principles
improve functional
ability
treatable but not
curable
Pathogenesis
• Nociceptive
• tissue damage and a normal nervous system
(e.g. pain associated with osteoarthritis)
• Neuropathic
• physiological nervous system dysfunction
• (e.g. diabetic neuropathy, postherpetic
neuralgia)
Specific Chronic Pain Disorders
•Myofascial Pain
•Osteoarthritis and Chronic Low Back Pain
•Fibromyalgia Syndrome
•Peripheral Neuropathy
Increasing the risks for in older patient
• higher percentage of body fat and decreases in
body water and muscle mass
• The livers is smaller and have less blood flow
• Increase renal disease
Pain Assessment
• Taking a Careful History
• A physical examination
• laboratory diagnostic studies
• X-rays
TREATMENT
Treatment
• Nonpharmacologic
• Pharmacologic
Nonpharmacologic Treatment
•Physical therapy
•Cognitive-behavioral therapy
Treatment Pharmacologic
–Nonopioid Pharmacologic Therapy
• NSAIDs
• Anticonvulsants
• Antidepressants
• Tramadol
• APAP
–Opioid Therapy for Nonmalignant Pain
Non-steroidal anti- inflammatory
drugs (NSAIDs)
NSAID – Risks in Older Adults
– GI toxicity especially among ≥ 75 years; similar to risk of patients
with peptic ulcer
– 1.7 x more likely to require antihypertensive therapy vs.
younger patients
– 10 fold increase in risk of falls
• Suspicion that CNS effects are the cause
• Falls also linked with CNS agents, diuretics, and hypnotics
Prescribing non steroidal anti-inflammatory drugs (NSAIDs) in
older adults: general considerations
_ Before prescribing an NSAID, clinicians should take a thorough
medical history that includes all co-morbidities, medications
(including over-the – counter and herbal medications) and
alcohol and tobacco use
_ Before beginning therapy, patients should have tests for renal
function, hepatic enzymes, platelets, and complete blood
count
_ After initiation of NSAID therapy, patients should be evaluated
every 2-4 weeks for the first 3 or4 visits.
…Prescribing non steroidal anti-inflammatory drugs (NSAIDs) in
older adults: general considerations
_ NSAIDs should be administrated at the lowest effective therapeutic dose
 Brief episodic NSAID therapy is preferable to long-term NSAID therapy
 NSAIDs with a shirt half-life may pose less risk of gastrointestinal bleeding than
those with a longer half-life
 Topical NSAIDs are an option for patients with pain in superficial joints
 Tramadol or Tramadol paracetamol (acetaminophen) is an alternative to
stronger Opioids when central analgesia is required and NSAIDs are
contraindicated
_ Patients receiving NSAIDs should consult physician before taking additional
prescribed or over-the-counter analgesics.
NSAIDs and COX-2 inhibitors should be considered rarely, and with extreme caution