|Clinical assessment of elderly patients must attempt to ascertain the presence of pain through both verbalized and nonverbalized symptoms.|
Selecting an optimal therapy depends on patient-specific criteria, including medical history, previous medications utilized, drug allergies, swallowing ability, and response to therapy. A description of the pain is also useful in determining initial therapy. Nociceptive pain, often the result of chronic or other conditions arising from actual tissue damage as in osteoarthritis, can be described as aching or soreness, rather than sharp pain. Neuropathic pain, arising from damaged nerve tissue, is usually described as burning, stinging or stabbing pain. To adequately manage chronic pain, the clinician should employ a step-therapy approach that uses regularly scheduled doses of medication rather than dependence on a regimen of “prn” doses. This avoids underdosing and its resulting inadequate pain relief. Titrating the dose and managing occasional variations in pain patterns are achieved through the use of rescue analgesics. Adjunct medications and nonpharmacologic interventions enhance the efficacy of analgesics; both are useful in managing chronic neuropathic and nociceptive pain. Adjunct medications may also have a positive effect on accompanying symptoms, including insomnia and depression. Therapy should be initiated in low doses, with gradual upward titration until pain relief is achieved.
Adequate pain management is a cornerstone of both palliative care and hospice care. Palliative care, the active care of a patient whose disease is not responsive to curative treatment, may be long-term. In contrast, a patient who is receiving hospice care has a life expectancy of six months or less. Regardless of the category of care the patient is receiving, appropriate management of pain and other associated symptoms is essential to the patient’s well-being and quality of life.