Pain is common among long-term care residents and is often undertreated. A high prevalence of dementia, sensory impairment, and disability, as well as structural issues such as staffing patterns and turnover in long-term care facilities make assessment and management of pain challenging. An overview of the evidence regarding the assessment and treatment of pain in individual residents, and recommendations for improving the overall quality of pain management in the long-term care setting, is presented.
Key words: pain, dementia, long-term care, pain assessment, pain management.
Older adults experience moderate to severe postoperative pain during and after their hospital stay. Preoperative education about pain management decreases postoperative pain. Postoperative pain management should generally include concurrent treatment of pre-existing chronic pain problems and a multimodal approach that incorporates postoperative opioids, nonopioids, and nonpharmacologic pain treatments. Opioids should be started at 25-50% of the adult dose and titrated until pain is reduced to a mild level. Older adults should be monitored closely to prevent side effects from opioid accumulation. A consistent pain scale that the older adult understands should be used to evaluate the pain response.
Key words: postoperative pain, pain assessment, opioids, nonopioids, nonpharmacologic treatments.
Sharon Watanabe, MD, FRCPC and Yoko Tarumi, MD, Tertiary Palliative Care Unit, Regional Palliative Care Program, Edmonton, AB.
Cancer pain is a significant problem in older adults. Management in this population is made more challenging by issues such as comorbid conditions and age-related alterations in drug disposition. The first step is to perform a multidimensional assessment in order to identify the various factors that may influence the perception and expression of pain. The second step is to apply a process of targeted interventions, which optimizes the use of pharmacological and non-pharmacological therapies and takes into consideration the unique characteristics of the older patient.
Key words: cancer pain, pain assessment, opioids, adjuvant analgesics.
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