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Roberta Rigo DalacorteMD. This article has been cited by other articles in PMC. The treatment of older adults with pain is complex and affected by age-related changes in pharmacokinetics and pharmacodynamics.
Chronic pain encompasses a complex array of sensory-discriminatory, motivational-affective, and cognitive-evaluative components. Because of this complexity, both pharmacologic and nonpharmacologic approaches should be considered to treat pain. Given the large number of older persons with pain at the end of life and the few data about this issue, the objective of this article is to review the treatment of pain in this population.
There are evidences of undertreatment among elderly people. The association of nonpharmacologic resources with the pharmacological treatment can help reduce the use of analgesics minimizing the side effects of long term medication. Pharmacological treatment is escalated in an orderly manner from non-opioid to weak opioid to strong opioid.
Adjuvant drugs like anticonvulsants and antidepressants may be necessary.
The sequential use of analgesics drugs and opioids are considered effective and relatively inexpensive for relieving pain, but no well designed specific studies in the elderly patient are available.
There are not specific recommendations about the long-term use of complementary and alternative therapies and although their effectiveness remains unproven they should not be discouraged. Palliative sedation may be a valid palliative care option to relieve suffering in the imminently dying patient.
Chronic pain, end of life care, older people, pharmacologic and nonpharmacologic approaches Introduction The phenomenon of population aging has been observed throughout the world and Brazil is one of the countries with the fastest rates of aging.
InBrazil will be the 6th country in number of elderly people worldwide. As consequence, the health profile of the population has changed.
There was a decrease of acute processes that evolve to cure or death and an increase in chronic degenerative non-communicable diseases NCDswhich nowadays are primarily responsible for disability and mortality in our population[ 12 ].
Elderly has the highest prevalence of comorbidity, disability, and frailty of any age group. Because of these characteristics the treatment of older adults with pain is complex and affected by age-related changes in pharmacokinetics and pharmacodynamics. Polypharmacy, defined as either the use of multiple medications or the use of unnecessary medications, is common in older people and increases the risk of adverse drug reactions, nonadherence, and increased cost[ 3 ].
Nowadays most elderly people die after a period of deterioration caused by one or more chronic progressive illnesses and the suffering that characterizes the period before death can be related, at least in part, to the experience of unrelieved symptoms.
Pain is among the most prevalent of these symptoms and management of chronic nonmalignant and malignant pain prevents disability and improves quality of life in elderly at the end of life.
Despite this, pain management is reported to be poor in elderly[ 45 ]. Because of this complexity, both pharmacologic and nonpharmacologic approaches should be considered to treat pain[ 6 ].
Given the large number of older persons with pain at the end of life and the few data about this issue, the objective of this article is to review the pharmacologic and nonpharmacologic approaches of the pain treatment in this population.
We included randomized controlled trials RCTs and reviews articles.
Pain assessment in the elderly The two most commonly used scales for adults are a verbal descriptor scale i.I don’t consider this degrading or abusive.
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