CC Nov 2017 Pain Management in the Elderly

echoecho's version from 2017-11-27 14:41


Question Answer
True or false? Chronic pain syndromes are frequently seen in elderly patients but are under recognized and often not treated appropriately?True
List the common disorders of chronic pain syndromes in the elderly?1) DJD of spine and knees 2)nocturnal leg cramps 3) neuropathy from diabetes 4) herpes zoster 5) pain associated with malignancy
Are the principles of pain management similar for both the elderly and younger adult?Yes
List these principles of pain management?1) chronic pain is best treated with scheduled mess as compared to as-needed dosing 2) dosing should begin with lower potency mess such as acetaminophen 3) adjunctive pain management strategies should be employed in the management of chronic pain (I.e. physical therapy, therapeutic exercise, joint injections, acupuncture, TENS units) 4) pain management should be individualized to the needs of the patient, titration doses carefully
What are the primary differences between chronic pain management in the elderly vs. the younger adult?Center around alterations in med metabolism brought about by natural aging and the increased incidence of co-morbid medical conditions seen in elderly patients
Elderly patients often have a _____ (higher vs. lower) pain threshold than younger patients? As a consequence, comment on the amount of dosages in the elderly?1) higher 2) smaller doses to avoid side effects
True of false? Medication combinations can be used at reduced doses with fewer side effects and good pain relief?True
What is the growing concern of pain management in patients with cognitive impairment (dementia or CVA patients)?Self-reporting of pain is the gold standard for assessment of pain, but this may not be true in patients with a decline in their ability to communicate verbally
*** Patients with dementia can experience chronic pain with same intensity as elderly patients without dementia. What is a sign of increasing pain in a nonverbal patient?a new decline in physical functions (refusal to walk or get out of bed). This functional declines indicates pain that is exacerbated by movement
Instead of self-reporting their pain, dementia patients may refuse to do what?undertake activities that cause pain
Pain assessments in elderly patients with dementia include asking about what?pain at rest and with various activities
When a patient with dementia is diagnosed with chronic pain, what is the management?1) begin with acetaminophen 2) schedule med doses at fixed intervals (especially before activities that may exacerbate pain) 3) titration med doses to achieve pain relief and maximize functional status 4) attempt to minimize adverse drug events
***Should pain be treated aggressively (balancing potential med side effects with pain relief)?yes
*** Is the presence of dementia a contraindication to the use of pain medication (even opioid meds)?no
Which medications that may alter cognitive function or increase the risks of falls should be monitored closely?1) opioids 2) anticonvulsants 3) muscle relaxants
Use of placebo meds in patients with known pain should be considered ______ in all patients?unethical
Cholinergic meds used in the dementia treatment have no effect on pain meds other than possibly what?slowing GI motility
All elderly patients on chronic pain meds should be monitored for adverse drug events. Meds with anticholinergic effects like TCAs can do what?increase the risk of cardiovascular events (orthostatic hypotension and tachyarrhythmias)
List the 5 common aging events that may affect medication metabolism?1) decreased renal clearance of medications 2) increased fat-to-muscle ratios (reducing clearance of fat soluble meds) 3) opioid-induced constipaton 4) reduction in gut motility (increasing opioid-induced constipation and slowing clearance of extended release opioids) 5) increased sensitivity to anticholinergic meds and side effects
Hepatic clearances of meds may be slowed due to ____, while some concomitant meds that increase hepatic metabolismis of pain meds?aging
NSAIDS can increase risk of what?upper GI bleeds, impair renal function and increase adverse cardiovascular events
In one study, NSAIDS were found to account for > ___% of hospitalizations from adverse med events?23
Use of ____ may reduce NSSAID-related upper GI bleeding but will not reduce nephrotic and cardiovascular events?PPIs
Identification and treatment of ________ infections can also reduce NSAID-associated gastrointestinal bleed?H. Pylori
What drug is considered the initial drug of choice for pain relief?Acetaminophen
Do transient elevation of LFTs preclude the use of acetaminophen in pain management?no
*** SUMMARY = True or false? Chronic pain is often seen among the elderly but is often NOT recognized or managed appropriately?true
*** SUMMARY = What techniques should be employed in chronic pain management in the elderly?use pharmacological and adjunctive pain management techniques
*** SUMMARY = List the medication management principles?1) scheduled dosing 2) slow titration of meds to higher doses 3) use of med combinations at smaller doses 4) close monitoring for side effects