‘Start low, go slow’ works for pain management in older patients


Starting low and going slow is better when it comes to working on the pain management of older patients, a new study has suggested. Chronic pain affects a large proportion of older adults and most long-term care residents. Managing chronic pain effectively is essential but challenging, and it has been complicated by concerns about opioid abuse. Pain management can be safely optimized with a plan that balances the risks and benefits of treatments.
The study was published in the journal - Mayo Clinic Proceedings. Treating chronic pain is best achieved when pharmacologic strategies and nondrug therapies are used at the same time.
"Chronic pain is very common in older adults, and is often associated with other issues, such as depression, insomnia, social isolation and poor quality of life," said researcher Brandon Verdoorn.
"While it's generally not curable, it can be managed with a systematic approach that begins with a thorough, function-based pain assessment followed by recognition and treatment of contributing conditions," added Verdoorn. Then the emphasis should be on initial low-risk strategies to address pain, which typically include noninvasive, nonpharmacological optio-ns, says Dr. Verdoorn, who co-authored the commentary with Christina Y. Chen, M.D., also a Mayo Clinic geriatrician and internist.
"Virtually every patient can benefit from these low-risk options. Some may wonder if pain medications can be safely used in older adults. This is a timely question, given the opioid crisis," said Dr. Chen.
"Though many medications used for managing chronic pain can have substantial adverse impacts, it's important to keep in mind that older adults also are affected by a pain epidemic. With judicious use, these medications, including opioids, are important tools for addressing chronic pain, which ultimately affects one's function and independence," added Chen. The study offers a practical, step-by-step framework that can assist providers who are treating older adult patients with chronic pain. The study suggests that during pain management of older individuals, people should begin with a thorough assessment of pain, focusing on the pain-related function which can be followed by addressing the associated conditions, such as depression and insomnia, at the same time.
Starting with low-risk pain management strategies, including nondrug methods that get the patient actively involved in her or his own improvement helps when followed by the use of higher-risk - often pharmacologic - strategies cautiously when needed. Frequent reassesses and discontinuation of ineffective treatments is the last and the important step.
Drs. Chen and Verdoorn also dispel some commonly held and inaccurate or misleading beliefs about the effects of pain medications on older adults, such as that opioid medications cause delirium and falls.
"Despite conventional wisdom, the idea that opioids cause falls is not supported by current evidence," said Dr Verdoorn. This may affect the pain management strategy for patients who have had falls or are at risk of falling.
"Though the elements of our framework are not new, they have not previously been conceptualized in this fashion as far as we are aware," said Dr Chen.
"The intent is to provide a useful in-office tool to help guide the management of chronic pain. With a careful and systematic approach, pain management can be safely optimized for older adults," she added. (ANI)

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