Pain Management in Senior Adults |
Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by
the
University of Alabama
School
of Medicine
Division of Continuing Medical Education,
Division of Gerontology, Geriatrics, and
Palliative Care, and
The Center for Aging
| Release
Date: August 10, 2007 |
Expiration
Date: August 10, 2010 |
| TARGET
AUDIENCE: |
| Primary
care physicians |
| OBJECTIVES: |
| Upon
completion of this CME activity,
physicians and other healthcare professionals
should be able to: |
- Discuss the prevalence of pain in older adults.
- List the different types of pain.
- Perform a pain assessment in cognitively intact and impaired older adults.
- Develop a pain management plan of care.
|
| Top of Page |
| SOURCE: |
| EDITOR
AND CONTRIBUTING AUTHORS: |
Angela
R. Curtis, PhD
Managing Editor
Assistant Professor, Geriatric Education
Manager
Kellie L. Flood, MD
Assistant Professor
Division
of Gerontology, Geriatrics and
Palliative Care
University of Alabama at Birmingham
Birmingham, Alabama |
| Top of Page |
| |
| DISCLOSURE: |
The
faculty has no commercial affiliations
to disclose.
Because of the nature of preliminary
studies, some products mentioned are
unlabeled and investigational. Dosages,
indications, and methods of use of
drugs mentioned in this publication
may reflect the experience of the authors,
clinical literature, or other resources.
Therefore, please see the full prescribing
information before using any licensed
product mentioned. |
| CME
PARTICIPATION: |
| To
participate in this online course
for CME credit, please review the
objectives before beginning the program.
Complete the course and the self-assessment
test before August 10, 2010 to receive
CME credit. Your certificate will
then be available online. This process
should take approximately 1 hour. |
| ACCREDITATION: |
The
University of Alabama School of
Medicine is accredited by the Accreditation
Council for Continuing Medical
Education to provide continuing
medical education for physicians.
The
University of Alabama School of
Medicine designates this educational
activity for a maximum of 1 AMA
PRA Category 1 Credit™.
Physicians should only claim credit
commensurate with the extent of
their participation in the activity.
The
boards of nursing in many states,
including Alabama, recognize Category
1 continuing medical education
courses as acceptable activities
for the renewal of license to practice
nursing. |
| DISCLAIMER: |
| Dosages,
indications, and methods of use of
any drug referred to in this publication
may reflect the clinical experience
of the authors, clinical literature,
or other clinical resources. Therefore,
please see the full prescribing information
before using any product mentioned.
UAB is an equal opportunity/affirmative
action institution. |
| INTRODUCTION: |
Many older adults will experience pain. An estimated 25-50% of community-dwelling and 45-80% of nursing home dwelling senior adults experience pain that interferes with their daily functioning.[1] The prevalence of pain is even higher in cancer patients. Up to 25% of cancer patients die without adequate relief from pain. This is despite the fact that cancer pain can be managed in 90% of these patients utilizing basic principles of pain management.[2]
The American Geriatrics Society Panel on Chronic Pain in Older Persons has published clinical practice guidelines for the assessment and treatment of pain in senior adults.[3] While these guidelines target chronic non-cancer pain, the basic principles espoused apply broadly to all sources of pain experienced by older adults. Some specific recommendations set forth in these guidelines for the assessment of pain in older adults include:
- Every older adult presenting for an initial evaluation to any health care service should be assessed for evidence of pain.
- In addition to using the specific term “pain” when interviewing older adults, providers should use synonyms (i.e., “discomfort”, “aching”, “soreness”, etc.) that senior adults may be more likely to utilize in their vocabulary.
- Pain that is impacting function or quality of life should be recognized as a significant problem.
- For adults with cognitive or language impairments, providers should interview caregivers and assess for non-verbal behaviors, vocalizations, and alterations in function that may be signs of pain.
A comprehensive pain assessment includes:[3]
- A medical history and physical examination, including a thorough neurological and musculoskeletal examination
- Determination of the characteristics of the pain
- Assessment of pain using a standard pain scale
- An analgesic history, including prescription, over-the-counter, and non-pharmacologic therapies and outcomes
- Evaluation of the impact of pain on functional status (i.e. instrumental and basic activities of daily living, gait, balance)
- Evaluation of the impact of pain on psychosocial functioning (i.e., mood, cognition, relationships).
|
| CASE 1: |
Ms. P is a 75-year-old African American female with metastatic breast cancer. She was treated with surgery, chemotherapy, and radiation, but her cancer continued to spread. She complains of constant severe pain in her chest and back, without radiation or paresthesia. Two weeks ago she was prescribed oxycodone 10 mg every 4 hours as needed.
|
|
