Handbook of Pain Relief in Older Adults (eBook)

Handbook of PainRelief in Older Adults 3
Copyright 4
Preface 5
Contents 7
Contributors 9
Chapter 1: Introduction 11
References 13
Chapter 2: Pain, Pain Everywhere…Almost 14
Terminology Issues 15
Reasons for Poor Pain Control in Seniors 16
Treatment and Recurrent Pain 18
More Regulation Not the Answer 20
Conclusion 21
References 21
Chapter 3: Assessment 24
Selecting Pain Scales for Seniors 25
Assessment of Pain When Communication Is Impaired 27
Research vs. Clinical Care Instruments 28
Beyond Screening Instruments 30
References 33
Chapter 4: AGS 2009 Guidelines for Pharmacological Management of Persistent Pain in Older Adults 35
Pharmacological Guidance for Pain Management in Older Adults 35
Specific Recommendations 36
NSAIDs 36
Opioids 37
Adjuvant 38
Other Drugs 38
Summary 41
References 42
Chapter 5: Spirituality as an Adjunct to Pain Management 43
Pain as a Complex, Multidimensional Experience 43
The Spiritual Dimension of Disease 44
Relationship Between Physical and Spiritual Pain 45
Interpretations of Personal Suffering 45
Cultural Issues and Spirituality 46
Clinical Goals of Spiritual Assessment and Care 48
Practical Application 49
Meaning Restoration Strategies 50
References 50
Chapter 6: The Role of Rehabilitation in Managing Pain in Seniors 53
Exercise 54
Physical Agent Modalities 55
Heat vs. Cold 56
Cryotherapy 56
Thermal Therapy 56
Electrotherapy 58
Manual Therapy 59
Kinematic Therapy 60
Conclusions 62
References 62
Chapter 7: Pharmacotherapy of Pain in Older Adults: Nonopioid 65
Factors to Consider 66
General Considerations 66
Perception of Pain in the Older Adult 67
Pharmacokinetic Considerations 67
Pharmacodynamic Considerations 68
Comorbid States 69
Other Considerations 69
Nonopioid Therapy 70
Acetaminophen 70
Mechanism of Action 70
Place in Therapy 70
Adverse Effects/Precautions 72
Summary 73
Nonsteroidal Anti-inflammatory Drugs 74
Mechanism of Action 74
Place in Therapy 75
Adverse Effects/Precautions 77
Gastrointestinal Toxicity 78
Renal Toxicity, Peripheral Edema, and Hypertension 81
Cardiovascular Disease and Thrombosis 82
Summary 83
Conclusion 84
References 84
Chapter 8: Pharmacotherapy of Pain in Older Adults: Opioid and Adjuvant 90
Opioids 90
Mechanism of Action 90
Place in Therapy 91
Adverse Effects/Precautions 94
Commonly Used Opioids 97
Less Preferred Opioids 101
Summary 102
Adjuvant Analgesics 103
Summary 107
References 108
Chapter 9: Interventional Strategies for Pain Management 112
Understanding the Pathology of the Pain 113
Pathophysiology of Pain 113
Nerve Blocks 114
Use of Local Anesthetics to Block a Nerve 114
Blocking Specific Sites 115
Facet Blocks 115
Sacroiliac Joint Injections 116
Sympathetic Blocks 116
Stellate Ganglion Block 116
Celiac Plexus Block 116
Lumbar Sympathetic Block 118
Superior Hypogastric Plexus Block 119
Ganglion Impar Block [19] 121
Nerve Destruction 121
Central Neurolysis 121
Electrical Stimulation of the Spinal Cord and Peripheral Nerves 122
Spinal Drug Delivery 124
Epidural Steroids 125
Intrathecal Therapy 125
Delivery Systems 127
Vertebroplasty and Kyphoplasty 128
Intradiscal Electrothermal Annuloplasty and Nucleoplasty 129
Botulinum Toxins 132
Conclusion 133
References 133
Chapter 10: Pain Management in Long-Term Care 138
Epidemiology of Pain in the Nursing Home 139
Barriers to Successful Pain Assessment and Management in the Nursing Home Patient 142
Assessment of Pain in the Nursing Home 144
Pain Management in the Nursing Home 146
Quality Improvement in the Nursing Home 149
Conclusion 150
References 151
Chapter 11: The Politics of Pain: Legislative and Public Policy Issues 154
Establishing Representation 155
Knowing the Candidates and Having Them Know You 156
Small Contributions Are Appreciated Too 157
Join Your Professional Society 158
Resisting Restrictive (and Costly) Regulation and Manipulation 158
The Fear of Legislation Can Be Just as Motivating 162
Specific Health System Obstacles 163
All Politics Are Local 164
When State Regulators Are Wrong 165
Do the Groundwork 165
Helping the Media Help You 166
Challenges from the Media 168
Conclusion 169
References 170
Chapter 12: The Internet and Electronic Medical Records to Assist with Pain Relief 171
Seniors and the Internet 172
EMR Use 172
Internet Sites of Interest 173
Pain Advocacy Web Sites 173
Pain Web Sites That Help to Identify Specialists in Pain Management 174
Pain Web Sites That Provide Pain Management Guidance 174
Web Sites That Rate Internet Sites 175
Other Web Sites 175
Web Sites on Diseases Where Pain Is the Predominant Feature 176
Fibromyalgia 176
Arthritis 176
Headache 176
Migraine 176
Neuropathic Pain 177
Sickle Cell Disease 177
Pelvic Pain 177
Vulvar Pain 177
Head and Neck Pain 177
EMR to Improve Pain Relief 177
Conclusion 180
References 180
Chapter 13: Navigating Pain Care: Trials, Tribulations, and Triumphs and Resources to Help 182
Challenges Aplenty 184
Common Pain Conditions in Older Adults 184
Advocating for Care 186
Consider Helping Older Patients 187
Rights to Care, Pain Management, and Health Coverage Laws 189
Pain Care Bill of Rights 189
Transition of Care 189
Overcoming Myths Stereotypes and Misunderstandings 191
Common Misperceptions about Pain 191
Tips for Self-care 192
Resources for Older People with Pain 194
Navigating the Health Care System 194
American Pain Foundation 195
Quality Care Advocacy Resources 195
Citizen Advocacy Center 196
National Long-Term Care Ombudsmen Resource Center 196
Administration on Aging Resources: Eldercare Locator 197
Patient Advocate Association 197
Elder Law: Legal Resources 197
Elder Law Answers 197
Caregiver Resources 197
Eldercare at Home 197
General Health and Aging 198
American Geriatrics Society 198
Centers for Disease Control and Prevention: Healthy Aging for Older Adults 198
National Institute on Aging 198
Alzheimer’s Association 198
Women’s Institute for a Secure Retirement (WISER) 199
References 199
Chapter 14: Suggestions for Change: Education, Policy, and Communication 200
Education 201
Policy 203
Communication 207
Conclusion 208
References 209
Index 210