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All older adults with chronic pain should undergo a comprehensive geriatric on the assessment and management of pain in older patients.
Table of contents
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- Management of chronic pain in older adults
- Opioids for persistent pain in older adults | Cleveland Clinic Journal of Medicine
- BPS/BGS management of pain in older people guideline
- What is chronic pain and how is it caused?
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Summary covers glycaemic targets for older people, priorities for improving high-quality diabetes care, and a useful frailty assessment pathway. A useful and informative algorithm on the management of asthma in adults over the age of 65 years. Site powered by Webvision Cloud. Skip to main content Skip to navigation.
Management of chronic pain in older adults
Care of the elderly. There is a need to further evaluate assessment tools that can specifically assess these aspects of communication see assessment guidelines: www.
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Adverse effects and contraindications limit the use of tricyclic antidepressants in older people Duloxetine has been shown to be effective for the treatment of neuropathic pain and some studies suggest efficacy for non-neuropathic pain such as osteoarthritis and low back pain Other antidepressants e. Referral to secondary care or pain clinics are often appropriate to obtain assessment regarding the use of such interventions.
IA hyaluronic acid HA is effective and relatively free of systemic adverse effects.
Opioids for persistent pain in older adults | Cleveland Clinic Journal of Medicine
It should be considered in patients intolerant to systemic therapy. IA HA appears to have a slower onset of action than IA corticosteroids, but the effects seem to last longer The evidence suggests that microvascular decompression is the treatment of choice for trigeminal neuralgia in healthy patients and percutaneous procedures are indicated for elderly patients with high comorbidity.
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- Guidance on the management of pain in older people;
What evidence does exist is generally weak and based upon small-scale studies without proper use of controls or randomisation procedures. Topics Care of the elderly Pain.
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Related articles. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile.
There are few absolute contraindications and relative cautions to prescribing paracetamol. Non-selective non-steroidal anti-inflammatory drugs NSAIDs should be used with caution in older people after other safer treatments have not provided sufficient pain relief.
BPS/BGS management of pain in older people guideline
The lowest dose should be provided, for the shortest duration. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug—drug and drug—disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life.
However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered.
Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and adverse effects limit their use in an older population.
Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients who are intolerant to systemic therapy.
What is chronic pain and how is it caused?
Intra-articular hyaluronic acid appears to have a slower onset of action than intra-articular steroids, but the effects seem to last longer. The current evidence for the use of epidural steroid injections in the management of sciatica is conflicting and, until further larger studies become available, no firm recommendations can be made. There is, however, a limited body of evidence to support the use of epidural injections in spinal stenosis.