Post on 21-Feb-2017
Pain in the Elderly Assoc. Prof. Brendan Moore
University of Queensland
Pain Medicine Specialist Brisbane Private Hospital and Greenslopes Private Hospital
Prevalence of Persistent Pain
• Prevalence is 17 % for males and 20% for females
• Prevalence increases with increasing age • Peaks at 27% for males aged 65 – 69 yrs • Peaks at 31% for females aged 80 – 84yrs
Blyth FM et al Pain 2001;89:127-‐134
Mul5ple Causes of Pain in Elderly
• Ageing does not cause pain • MulRple pathologies increase with age,
some of which may be painful • May have mulRple causes of pain • New symptoms require proper evaluaRon
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002
Does Sensi5vity to Pain change with age?
Discussion Point
Pain Sensi5vity may differ with Increasing Age • Elderly may have higher thresholds to Pain • The Elderly may experience less Pain at
lower levels of sRmulaRon • But once felt as pain, the sensaRon is no
different from younger people
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002
Can people with Demen5a accurately
report Pain?
Discussion Point
Demen5a and Repor5ng of Pain • Able to report current pain • Past pain reports less accurately reported • As demenRa increases, ability to report
pain decreases • As communicaRon fails, importance of
observaRon increases
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002 McClean WJ. Nursing & ResidenRal Care 2003:5(9) 428-‐430
Influence of Cogni5on
People with demenRa are more likely to have pain that is not treated
ContribuRng factors: • Less likely to volunteer informaRon • Less likely to complain about pain
McClean WJ. Nursing & ResidenRal Care 2003:5(9) 428-‐430
Degenera5ve Lumbar Back Pain
Assessing Back Pain
• Is the pain mechanical? • Are there neurological features? • Is there correlaRng leg pain? • Are further invesRgaRons required?
Pharmacological Treatment of Pain
In the Elderly
Special Considera5ons in the Elderly
• MulRple sources of Pain • ComorbidiRes and polypharmacy • Reduced effecRve renal funcRon • Reduced muscle mass, increased adipose • Increased drug sensiRvity
Mashford et al. TherapeuRc Guidelines: Ed 4. 2002 NaRonal Prescribing Service. Drug use in the elderly. PPR26 July 2004
Opioids
Opioid Trial Guidelines • Use low dose, sustained release opioid Start Low and Go Slow
for paRents who are: • Elderly • Taking other CNS depressants • Opioid naïve • Have hepaRc or renal insufficiency
Opioid Dose Equivalence
MAXIMUM Opioid Dose Guide
Principles of Good Prescribing in the Elderly • Prescribe lowest effecRve dose • Small number of medicaRons • Simple dose regime • Simple verbal and wrihen instrucRons
NaRonal Prescribing Service. Drug use in the elderly. PPR26 July 2004
“Pain is not a normal part of aging
and should be evaluated as in any other age group”
Pain the Fi/h Vital Sign
American Pain Society Mashford et al. TherapeuRc Guidelines: Ed 4. 2002
Thank you