Persistent pain conditions in the elderly are most often due to degenerative disorders of the spine, osteoarthritis of the joints, malignant cancer, and vascular disorders. The consequences of persistent pain include depression, anxiety, de-creased socialization, sleep disturbance, impaired ambulation, and increased healthcare utilization. Proper pain assessment is the key to selecting appropriate treatment. Barriers to pain assessment are associated with the patient's perception of pain and the caregiver's attitude towards providing effective treatment. All elderly patients have age-related physiologic changes that affect absorption, distribution, metabolism, and clearance of medications used for pharmacologic treatment. Medications used in pain management include opioids, nonsteroidal anti-inflammatory drugs, gabapentin, nortriptylline, desipramine, and lidocaine 5%patch. Pharmacists have an important role in the monitoring of medications in elderly. As the utilization of prescription medication continues to increase in the elderly, pharmacists are becoming the frontline of healthcare care for this population.
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References
1.
1. US Bureau of the Census. Statistical Abstract of the United States: 2002. Available at: http://www.census.gov/statab.
2.
2. The management of persistent pain in older person. AGS panel of persistent pain in older persons . JAG. 2002;50: S205-S224 .
3.
3. Mitchell C. Assessment and management of chronic pain in elderly people . Br J Nurs. 2001;10(5): 296-304 .
4.
4. Gagliese L, Melzack R. Chronic pain in elderly people . Pain. 1997;70(1): 3-14 .
5.
5. Ryan P, Vortherms R, Ward S. Cancer pain:knowledge, attitudes of pharmacologic management . J Gerontol Nurs. 1994;20: 7-16 .
6.
6. Brunier G, Carson MG, Harrison DE. What do nurses know and believe about patients with pain? J Pain Sympt Manage. 1995; 10: 436-445 .
7.
7. Weiner DK, Rudy TE. Attitudinal barriers to effective treatment of persistent pain in nursing home residents . JAG. 2002;50: 2035-2040 .
8.
8. Chodosh J, Ferrell BA, Shekelle PG, Wenger NS. Quality indicator for pain management in vulnerable elders . Ann Intern Med. 2001;135: 731-735 .
9.
9. Kerns RD, Otis JD, Stein Marcus K. Cognitive-behavioral therapy for chronic pain in the elderly . Clin Geriatr Med. 2001;17(3): 503-523 .
10.
10. Davis MP, Srivastava M. Demographics, assessment, and management of pain in the elderly . Drugs Aging. 2003;20(1): 23-57 .
11.
11. Lipetz JS. Pathophysiology of inflammatory, degenerative and compressive radiculopathies . Phys Med Rehabil Clin N Am. 2002;13(3): 439-449 .
12.
12. Bigos SJ, Muller G. Low back pain. In: Loeser JD, ed. Bonica's Management of Pain. 3rd ed. Philadelphia: Lippincott Williams and Wilkins ; 2001:1508-1528.
13.
13. Deyo RA, Weinstein JN. Low back pain . N Engl J Med. 2001;344(5): 363-370 .
14.
14. Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N. Diagnosis and management of vertebral fractures in elderly adults . Am J Med. 2002;113(3): 220-228 .
15.
15. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. Glenview, Il: American Pain Society ; 2002.
16.
16. Loeser JD. Cranial neuralgias. In: Loeser JD, ed. Bonica's Management of Pain. 3rd ed. Philadelphia: Lippincott Williams and Wilkins ; 2001:855-866.
17.
17. Biondi DM, Saper JR. Geriatric headache: how to make the diagnosis and manage the pain . Geriatrics. 2000;55(12): 40-50 .
19. Rowbotham M, Hardin N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia . JAMA. 1998;280: 1837-1842 .
20.
20. Rice AS, Maton S. Gabapentin in postherpetic neuralgia: a randomized, double blind, placebo controlled study . Pain. 2001;94: 215-224 .
21.
21. Wasner G, Schattschneider J, Binder A, Barone R. Complex regional pain syndrome diagnostic, mechanisms, CNS involvement and therapy . Spinal Cord. 2003;41: 61-75 .
23. Johansen KH. Pain due to vascular disease. In: Loeser JD, ed. Bonica's Management of Pain. 3rd ed. Philadelphia: Lippincott Williams and Wilkins ; 2001:587-612.
24.
24. Freedman GM. Clinical management of common causes of geriatric pain . Geriatrics. 2002;57: 36-41 .
25.
25. Peng PW, Sandler AN. A review of the use of fentanyl analgesia in the management of acute pain in adults . Anesthesiology. 1999;90: 576-599 .
26.
26. Grond S, Radbruch L, Lehmann KA. Clinical pharmacokinetics of transdermal opioids . Clin Pharmacokinet. 2000;38(1): 59-89 .
27.
27. Sarhill N, Walsh D, Nelson KA. Hydromorphone: pharmacology and clinical applications in cancer patients . Support Care Cancer. 2001;9(2): 84-96 .
28.
28. Quigley C, Wiffen P. A systematic review of hydromorphone in acute and chronic pain . J Pain Symptom Manage. 2003;25(2): 169-178 .
29.
29. Hanks GW, Conno F, Cherny N, et al. Morphine and alternative opioids in cancer pain: the EAPC recommendations . Brit J Cancer. 2001;84(5): 587-593 .
30.
30. Donnelly S, Davis MP, Walsh D, Naughton M. Morphine in cancer pain management: a practical guide . Support Care Cancer. 2002;10: 13-35 .
31.
31. Andersen F, Christrup L, Sjogren P. Relationships among morphine metabolism, pain and side effects during long-term treatment: an update . J Pain Symptom Manage. 2003;25(1): 74-91 .
32.
32. Inturrisi CE. Clinical pharmacology of opioids for pain . Clin J Pain. 2002;18: S3-S13 .
33.
33. Wheeler WL, Dickerson ED. Clinical applications of methadone . Am J Hospice Palliat Care. 2000;17(3): 196-203 .
34.
34. Ripamonti C, Bianchi M. The use of methadone in cancer pain . Hematol Oncol Clin North Am. 2002;16(3): 543-555 .
35.
35. Roth SH, Fleischman RM, Burch FX, et al. Around the clock controlled release oxycodone therapy for osteoarthritis related pain . Arch Intern Med. 2000;160: 853-860 .
36.
36. O'Mahony S, Coyle N, Payne R. Current management of opioid-related side effects . Oncology. 2001;15(1): 61-82 .
37.
37. Latta K, Ginsberg B, Barkin R. Meperidine, a critical review . Am J Ther. 2002;9: 53-68 .
38.
38. Hawkins C, Hanks GW. The gastroduodenal toxicity of nonsteroid anti-inflammatory drugs: a review of the literature . J Pain Symptom Manage. 2000;20(2): 140-151 .
39.
39. Catella-Lawson F, McAdam B, Morrison BW, et al. Effects of specific inhibition of cyclooxygenase-2 on sodium balance, hemodynamics, and vasoactive eicosanoids . J Pharmacol Exp Ther. 1999;289: 735-741 .
40.
40. Whelton A, Schulman G, Wallemark C, et al. Effects of celecoxib and naproxen on renal function in the elderly . Arch Intern Med. 2000; 160: 1465-1470 .
41.
41. Swan SK, Rudy DW, Lasseter KC, et al. Effect of cycloooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet . Ann Intern Med. 2000;133: 1-9 .
42.
42. Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials . Clin Ther. 2003;25(1): 81-104 .
43.
43. Hirschfeld RM. Efficacy of SSRIs and newer antidepressants in severe depresssion: comparisons with TCAs . J Clin Psychiatry. 1999;60: 326-335 .
45. Gammaitoni AR, Alvarez NA, Galer BS. Safety and tolerability of lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature . J Clin Pharmacol. 2003;43: 111-117 .
