Experts give advice
Top 10 recommendations on pain management
The following recommendations are from the recently published clinical practice guidelines developed by the American Geriatrics Society in New York City.
1. Make pain relief a priority. Whenever pain is present, providing treatment to relieve the pain is just as important as determining its cause. Patients should be taught to discuss painful symptoms with health care providers.
2. Use standard pain scales. It is often difficult to describe the quality and intensity of pain. For this reason, standard measures such as a word list or a visual or numeric pain scale should be used to quantify both the severity of pain and its response to treatment.
3. Use NSAIDs with caution. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin can have significant side effects - as severe as kidney and liver damage - to varying degrees in older patients.
4. For mild to moderate musculoskeletal pain, use acetaminophen first. Acetaminophen is the preferred drug for relieving mild to moderate musculoskeletal pain, but it should be used under direction of the health care provider.
5. Use narcotics for severe pain. Opioid pain relievers are effective in relieving moderate to severe pain. Health care professionals should discuss the medications with the patient and see if opioids are appropriate.
6. Monitor patients closely. Sometimes, a patient's pain-sensing system goes awry. There are a variety of non-narcotic analgesics that are proven to be effective in the treatment of some neuropathic pain. In such situations, however, physicians should monitor patients closely.
7. Don't rely on medications alone. Non-phar macologic approaches include patient and caregiver education, cognitive - behavioral therapy, exercise programs, and other modalities. Those approaches can be used alone or in combination with medication, and they should be part of the care plan for most patients with chronic pain.
8. Refer patients who still have pain. Health care providers should not hesitate to refer patients to multidisciplinary pain management centers when pain-relief goals are not being met.
9. Lobby for greater availability of narcotic opioid pain relievers. Regulatory agencies such as the U.S. Department of Justice's Drug Enforcement Agency should revise policies to make opioid pain relievers more readily available to older patients.
10. Educate patients about pain. Patients should learn more about pain management, and pain management education should be improved for health care professionals at all levels.
(Editor's note: Information for this article was taken from The Management of Chronic Pain in Older Persons, American Geriatrics Society.)
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