06/05/2022
Pain control in the elderly
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The article was written by Emergency Medicine Doctor - Emergency Resuscitation Department - Vinmec Phu Quoc International General Hospital.
Acute or chronic pain is one of the most common complaints of the elderly. Evaluation and treatment of pain syndrome in the elderly can be difficult. Cognitive impairment, particularly in home-care patients, may cast doubt on the reliability of pain complaints. Pain syndromes such as acute myocardial infarction and intra-abdominal emergencies are often atypical, even absent, in the elderly.
1. World Health Organization pain relief scale
As a matter of fact, elderly patients are at risk of either over- or under-treatment of pain syndromes. Other consequences of inadequate pain management include depression, malnutrition, multiple medications, cognitive dysfunction, and functional impairment. Acute pain is defined by its very pronounced onset and duration of pain of less than 6 weeks, with chronic pain being more prolonged.
Drug therapy is the cornerstone of the treatment of acute and chronic pain from cancer. The World Health Organization's Pain Scale establishes drug treatment into three steps:
(1) Non-OPIs;
(2) low-dose OPIs;
(3) higher dose opioids;
Steroid use causes Cushing's syndrome
Elderly patients using drugs to treat acute and chronic pain caused by cancer
Treatment is initiated with non-OPIs, and additional opioids are added as needed. It is important to keep in mind that when using combinations of OPIs and acetaminophen (eg, acetaminophen plus codeine (Tylenol), oxycodone plus acetaminophen (Percocet)) patients should not take more than 4000mg of acetaminophen per day.
Adjuvant therapy, such as tricyclic antidepressants, caffeine, or antispasmodics can be added at any step.
