Speaker: Date: Topic
Angela Catic, MD
May 28, 2014
Geriatric Pain Management: A Practical Approach
Responsibility for Content
The WebEx video, PowerPoint presentation, take-away points, and article links were sent by the Medical Library and the CME Committee.
Diane E. Young, Information Specialist
Take-Away Points of the Presentation
1. Pain is common and underreported in patients age 65 years and older. It is important to ask patients about their pain during every clinical encounter. In elders with advanced dementia who are nonverbal, an observational tool such as the PAINAD scale should be used to assess pain.
2. Scheduled acetaminophen is the first line analgesic agent in patients age 65 years and older. NSAIDs should be used sparingly only in situations where an anti-inflammatory effect is needed and their use should be time limited. They should be given with food or a gastro protective agent.
3. Be aware that tramadol has a similar side effect profile as the stronger opioids and is often not as efficacious in elders. Oxycodone at low doses is often well tolerated among geriatric patients.
4. Anticipate side effects before they occur. Always start a bowel regimen with any opioid based analgesic agent.
Links to Articles Cited in the Presentation
- Altman RD: New guidelines for topical NSAIDs in the osteoarthritis treatment paradigm. Curr Med Res
- Backonja MM: NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neura
- Baraf HS: Part One: Safety and efficacy of topical diclofenac sodium gel for knee osteoarthritis in
- Baraf HS: Part Two Safety and efficacy of topical diclofenac sodium gel for knee osteoarthritis in e
- Cepeda MS: Tramadol for osteoarthritis. Cochrane Library 2009, Issue 1.
- Driver LC: Case studies in breakthrough pain. Pain Med 2007;8 Suppl 1:S14-8.
- Erlich DR: Tapentadol (nucynta) for treatment of pain. Am Fam Physician 2012;85(9):910-1.
- Flores MP: Topical analgesics. Rev Bras Anestesiol 2012;62(2):244-52.
- Fong HK: The role of postoperative analgesia in delirium and cognitive decline in elderly patients:
- Gloth FM 3rd: Pain management in older adults: prevention and treatment. J Am Geriatr Soc 2001;49(2)
- Lynch EP: Patient experience of pain after elective noncardiac surgery. Anesth Analg 1997;85(1):117-
- Mann C: Postoperative patient-controlled analgesia in the elderly: risks and benefits of epidural vs
- Mason L: Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 2004;328(7446
- McKeage K: Pregabalin: in the treatment of postherpetic neuralgia. Drugs Aging 2009;26(10):883-92.
- Moore RA: Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of ra
- Morrison RS: Relationship between pain and opioid analgesics on the development of delirium followin
- Pappagallo M: Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg 2001;182(
- Payne R: Recognition and diagnosis of breakthrough pain. Pain Med 2007;8 Suppl 1:S3-7.
- Peniston JH: Long-term tolerability of topical diclofenac sodium 1% gel for osteoarthritis in senior
- Roth SH: Pooled safety analysis of diclofenac sodium topical solution 1.5% (w/w) in the treatment of
- Rowbotham M: Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial.
- Schmader KE: Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabet
- Semel D: Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain
- Shah SA: Is peripheral alcohol injection of value in the treatment of trigeminal neuralgia? An analy
- Smith M: Pain assessment in nonverbal older adults with advanced dementia. Perspect Psychiatr Care 2
- Stacey BR: Management of peripheral neuropathic pain. Am J Phys Med Rehabil 2005;84(3 Suppl):S4-16.
- Swegle JM: Management of common opioid-induced adverse effects. Am Fam Physician 2006;74(8):1347-54.
- Warden V: Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINA
- Zacher J: Topical diclofenac and its role in pain and inflammation: an evidence-based review. Curr M