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Effective Techniques for Pain Management in the Elderly

June 11, 2018

Pain can be debilitating. Muscle aches, nerve pain, joint pain—these and other pain related issues have the potential to dramatically impact a person’s quality of life. Constant pain can cause everyday activities, such as enjoying a walk or self-care, to become too burdensome. Chromic pain can lead to loss of independence and increased isolation. As care providers, it is essential we understand the causality and best pain management options to promote wellness for those who experience acute and chronic pain.

The National Pain Strategy (NPS), developed by the Interagency Pain Research Coordinating Committee (IPRCC) and other private and public organizations, has identified a lack of pain self-management programs and is working to supply patients with “appropriate skills, education, and resources to actively manage their pain.”

According to the US National Library of Medicine inadequate pain management in the elderly can commonly be attributed to 4 misconceptions:

1.    Pain is a natural part of getting older

2.    Pain worsens over time

3.    Stoicism leads to pain tolerance

4.    Prescription analgesics are highly addictive

Untreated pain can also cause a change in a resident’s mental health. Debilitating pain can lead to agitation, depression and even anxiety. Many times, treating the underlying pain helps improve these common mental health concerns.


Strategies for Effective Pain Management in the Elderly

To treat the problem, we must first understand the patient. Statistically, up to 80% of nursing home residents experience considerable pain. There are many different types of pain, each with different medications for treatment, including:

  • Arthritis – Pain from arthritis is often treated with APAP (acetaminophen), NSAIDs (non-steroidal anti-inflammatory drugs), aspirin or Tramadol (Ultram).
  • Peripheral Neuropathy – Caused by damage to the peripheral nerves, this pain is treated with Gabapentin/Lyrica, TCAs (Tricyclic antidepressants) or Cymbalta.
  • Acute Inflammatory Pain – NSAIDs can help treat pain from inflammation.
  • Musculoskeletal or Bone Pain – This type of pain is most often treated with opioids.
  • Comfort Care – When a resident’s comfort is the priority, pain can be treated with Roxanol or Benzos.

An additional comprehensive pain management challenge is that, as we age, the physiology of our bodies changes. In later years, muscle mass decreases and body fat fluctuates. These changes impact how senior bodies absorb medication. Additionally, metabolism rates and elimination patterns change. This impacts how the body breaks down and removes medications.

These physiological changes make a dedicated pharmacy partner essential. Your pharmacy team needs a dedicated team member who reviews resident medications and medical history on an on-going, monthly basis, to identify practical pain management solutions. As a dedicated and integral member of your facility’s wellness team, HealthDirect’s experienced professionals understand the importance of providing the right care, for the right patient, at the right time.

Patient Assessment and Practical Pain Management

The best way to measure pain is through self-assessment. Since pain tolerance and self-assessment varies by resident, practical pain management techniques are available to help provide comprehensive pain management. 

PQRST, Pain Scales, and Patient Assessment

To understand the level of pain a resident is in, pain scales that number 1-10 or that ask the resident to be descriptive, such as stating “mild” or “moderate”, are often effective. For residents with dementia, the use of facial expressions can also work as a good indicator. An additional tool, known as “PQRST”, takes a deeper look at what causes the pain by asking questions such as:

  • P – Palliative factors: What makes the pain better?
  • Q – Quality: What does the pain feel like?
  • R – Radiation: Where is the pain and does is radiate anywhere?
  • S – Severity: How does it compare to other pain you have experienced?
  • T – Temporal factors: Does the pain change with time or worsen with food or movement?

Pharmacy's Role in Senior Pain Management

Along with pharmacological, other treatments such as heat, ice, PT/OT, and massage can work well for residents. These types of non-pharmacological interventions should always be tried before prescribing medications – and used often alongside of medications – to ensure the lowest effective dose is being used to mitigate pain.

However, once it’s determined that medication is needed, there are general principles to help guide in finding the most therapeutic level of treatment for our residents:

  • Start low, titrate slow
  • When appropriate, more than one drug can be used
  • Use the least invasive method of administration
  • Frequently assess efficiency and safety
  • Titrate upward as necessary


An Interdisciplinary Approach for Pain Management in The Elderly

Because comprehensive pain management is an entire body process that impacts many facets of a resident’s well-being, it is important than an interdisciplinary team consisting of doctors, nurses, physical and occupational therapy and pharmacy work together to enhance quality of life and find therapeutic ways to reduce resident pain. As an ally to your facility and an integral member of the interdisciplinary team, HealthDirect’s greatest goal is to promote resident wellness. This is achieved by through the combination of on-going communication, personalized care and the implementation of technology solutions in a way that only HealthDirect can offer.  

If you are ready to know more about how HealthDirect can help the residents in your facility effectively manage pain, call us at (888) 708-3999. Our knowledgeable team is available from Monday – Friday, 8:00am to 4:30 pm EST. Or, if you prefer, visit our contact page to connect with us.  
 


Sources:

Ninds. “National Pain Strategy A Comprehensive Population Health-Level Strategy for Pain .” National Pain Strategy - A Comprehensive Population Health -Level Strategy for Pain, 11 Mar. 2016, iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf

Pizzolanti, Jan. Implementing More Effective Pain Strategies Implementing More Effective Pain Strategies, Experience RX Consults, 2017.

Thielke, Stephen, et al. “Aging: Are These 4 Pain Myths Complicating Care?” The Journal of Family Practice, Frontline Medical Communications Inc, Nov. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC4356472/

Zwakhalen, Sandra MG, et al. “Nursing Staff Knowledge and Beliefs about Pain in Elderly Nursing Home Residents with Dementia.” Pain Research & Management : The Journal of the Canadian Pain Society, Pulsus Group Inc, 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2670708/

Brandi VanValkenburg

Brandi provides personalized care as a pharmacy consultant with HealthDirect's northeastern region.  She's been serving our clients for nearly 10 years. 

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