Clinical Management of the Elderly Patient in Pain

by Smith; Howard

• ISBN13: 9780789026200
• ISBN10: 0789026201
• Edition: 1st
• Format: Nonspecific Binding
• Copyright: 2006-05-11
• Publisher: CRC Press

Summary

Up-to-date information on pain management--including options to consider when conventional treatment is ineffective Providing effective treatment for pain-especially to elderly clients-can be a vexing problem for even the most knowledgeable clinician. In Clinical Management of the Elderly Patient in Pain, some of the world's leading authorities describe the unique difficulties that arise when trying to provide pain relief to elderly patients. They examine conventional treatment with opioid and non-steroidal anti-inflammatory drugs along with a broad range of alternatives to consider when frontline drugs fail. Non-drug options for pain relief from the fields of physical medicine and psychology are also explored. Essential topics addressed in Clinical Management of the Elderly Patient in Pain include: pain as an aspect of advancing age how pharmacology differs in elderly patients available therapeutic options, including opioids, non-steroidal anti-inflammatory drugs, anti-epileptic drugs, tricyclic antidepressants, membrane stabilizers, and topical agents physical medicine approaches psychological approaches to pain in the elderly Most publications on this subject focus on the use of opioids, non-steroidal drugs, and other commonly prescribed analgesics. Clinical Management of the Elderly Patient in Pain takes a different approach. Editor Gary McCleane, MD, says, Our need, with elderly patients, is to provide treatment that is both effective and easily tolerated. This is not a book devoted to opioids and non-steroidals, although they are addressed. Nor is it about those analgesics used in younger patients being used in smaller doses with the elderly. Rather, it contains practical options for treating pain when other simple remedies fail to help. At times this will involve using conventional analgesics in scaled-down doses, but at others it will involve using substances not yet fully recognized as possessing analgesic properties because they fit the bill in terms of possible analgesic actions, side-effect profiles, and lack of drug/drug interactions--and because practical experience suggests they may be useful in the scenario described.” Clinical Management of the Elderly Patient in Pain is designed as a point of interface between the specialist pain practitioner and the clinician faced with all the problems of satisfactorily managing pain in elderly patients. It presents commonsense, practical, patient-oriented options that make it a useful resource for busy clinicians.

Table of Contents

About the Editors	xi
Contributors	xiii
Preface	xv
Chapter 1. Pain and the Elderly Patient	1	(10)
Gary McCleane
An Aging Population	1	(1)
Neural Differences in the Aged	2	(1)
Effect of Age in Animal Pain Models	3	(1)
Effect of Age on Human Experimental Pain	4	(2)
Effect of Age on Clinical Pain	6	(1)
Conclusion	7	(4)
Chapter 2. Acute and Chronic Pain in the Elderly	11	(12)
Pradeep Chopra
Howard Smith
Acute Pain	13	(1)
Chronic Pain	14	(2)
Cancer Pain	16	(7)
Chapter 3. Pain Management and Pharmacological Differences in the Elderly Patient	23	(6)
Peter Passinore
David Craig
External Factors	23	(1)
Pharmacokinetic Alterations	24	(2)
Pharmacodynamic Changes	26	(1)
Conclusion	27	(2)
Chapter 4. Acetaminophen for the Elderly	29	(6)
Pradeep Chopra
Howard Smith
Clinical Pharmacology	29	(1)
Adverse Effects	30	(1)
Laboratory Values Affected	31	(1)
Overdosage	31	(1)
Dosage and Administration	32	(3)
Chapter 5. Opioids	35	(22)
Gary McCleane
Does Age Influence the Dose of Opioid Required to Achieve Analgesia?	36	(1)
Pain and Its Responsiveness to Opioids	36	(1)
Types of Opiod	37	(6)
Side Effects of Opioid Analgesics	43	(5)
Clinical Use of Opioids in the Elderly	48	(1)
Conclusion	49	(8)
Chapter 6. NSAIDs and the Elderly	57	(12)
Jennifer A. Elliott
Mechanism of Action and Physiological Effects of NSAIDs	57	(4)
Classification of NSAIDs and Individual Agents of Particular Concern in the Elderly	61	(4)
Potential Adverse Drug Interactions with NSAIDs in the Elderly	65	(2)
Conclusion	67	(2)
Chapter 7. Tramadol for the Elderly	69	(6)
Pradeep Chopra
Howard Smith
Clinical Pharmacology	69	(1)
Adverse Events	70	(1)
Dosage and Administration	71	(1)
Guidelines for Using Tramadol in the Elderly	72	(3)
Chapter 8. Topical Local Anesthetics	75	(16)
Charles Argoff
The Use of Topical Local Analgesics for Neuropathic Pain	80	(3)
The Use of Targeted Peripheral Analgesics for Pain Associated with Soft Tissue Injury and Osicoarthritis	83	(1)
The Use of Targeted Peripheral Analgesics for the Treatment of Low Back Pain and Myofascial Pain	84	(1)
Other Uses of Topical Analgesics	85	(1)
Summary	86	(5)
Chapter 9. Nitrates, Capsaicin, and Tricyclic Antidepressants	91	(16)
Gary McCleane
Nitrates	91	(4)
Capsaicin	95	(4)
Tricyclic Antidepressants	99	(2)
Conclusion	101	(6)
Chapter 10. Topical Opioids	107	(10)
Gary McCleane
Peripheral Opioid Receptors	107	(1)
Effect of Peripheral Application of Opioids for Acute Pain	108	(1)
Transdermal Fentanyl	109	(1)
Topical Morphine	110	(1)
Transdermal Buprenorphine	111	(1)
Other Modes of Administration of Strong Opioids	111	(1)
Conclusion	112	(5)
Chapter 11. Tricyclic Antidepressants As Analgesics in the Elderly	117	(16)
Mary E. Lynch
Jana Sawynok
Systemic Tricyclic Antidepressants As Analgesics	118	(4)
Other Antidepressants As Analgesics	122	(2)
Comorbid Pain and Depression	124	(1)
Mechanisms of Action of Antidepressants As Analgesics	124	(4)
Topical Antidepressants As Analgesics in Clinical Studies	128	(5)
Chapter 12. Antiepileptics	133	(16)
Gary McCleane
Neuropathic Pain	134	(1)
Selecting an AED	135	(1)
Specific AEDs	136	(3)
Side Effects of AEDs	139	(1)
Examples of Conditions That May Respond to Use of an AED	140	(3)
Conclusion	143	(6)
Chapter 13. Spinal Analgesia in the Elderly	149	(30)
Thomas M. Larkin
Steven P Cohen
Definitions	149	(1)
Physiological Considerations	150	(1)
Anatomical Considerations	151	(1)
Neuraxial Analgesics in Perioperative and Chronic Pain Conditions	151	(1)
Local Anesthetics	152	(1)
Opioids	152	(3)
Alpha-2 Adrenergic Agonists	155	(2)
N-Methyl-D-Aspartate Receptor Antagonists	157	(2)
Calcium Channel Blockers	159	(1)
Adenosine	160	(1)
Cholinergic Agonists	161	(2)
Gamma-Aminobutyric Acid Agonists	163	(2)
Somatostatin	165	(1)
Neuroleptics	166	(2)
Aspirin and NSAIDs	168	(1)
Conclusion	169	(10)
Chapter 14. Oral and Intravenous Local Anesthetics	179	(18)
Gary McCleane
Oral Local Anesthetics	180	(1)
Intravenous Local Anesthetics	181	(6)
Conditions Benefiting from Intravenous Lidocaine	187	(3)
Suggested Clinical Use	190	(2)
Conclusion	192	(5)
Chapter 15. Muscle Relaxants	197	(10)
Howard Smith
Pharmacological Considerations for the Use of Muscle Relaxants in the Elderly	198	(3)
Muscle Relaxant Agents	201	(3)
Other Agents and Treatments	204	(1)
Summary	205	(2)
Chapter 16. Physical Therapy and Pain Management with the Elderly	207	(12)
Dennis Martin
Function	207	(1)
Context	208	(1)
Consequences of Pain in the Elderly	209	(1)
Models of Pain Management	210	(1)
Role of the Physical Therapist	210	(2)
Physical Therapy Treatments	212	(1)
Goal Setting	213	(2)
Conclusion	215	(4)
Chapter 17. Psychosocial Factors in Pain Management of the Older Patient	219	(20)
Edmund J. Burke
Age Differences in Prevalence Rates of Chronic Pain	220	(1)
The Nature of Pain States	221	(1)
Physical Differences in Pain Perception	221	(2)
Sociocultural Factors in the Experience and Report of Pain in Older Patients	223	(1)
Emotional and Psychological Factors Influencing Pain Experience	224	(4)
Practical Issues in the Assessment and Treatment of the Elderly Pain Patient	228	(6)
Summary	234	(5)
Chapter 18. Use of Psychotropic Medications in Geriatric Pain Management	239	(24)
Guerman Ermolenko
Antidepressants	239	(9)
Antipsychotics	248	(4)
Significant Side Effects and Interactions of the Antidepressants	252	(1)
Strategies for Combined Psychiatric and Pain Syndromes	253	(2)
Conclusion	255	(8)
Chapter 19. Treatment of Common Conditions	263	(16)
Gary McCleane
Central Poststroke Pain	263	(1)
Cervical Radiculopathy	264	(1)
Fibromyalgia	265	(1)
Fracture Pain	266	(1)
Metastatic Bone Pain	267	(1)
Muscle Spasm	267	(1)
Osteoarthritis—Monoarticular	268	(1)
Osteoarthritis—Polyarticular	269	(1)
Painful Diabetic Neuropathy	270	(2)
Peripheral Vascular Disease	272	(1)
Postherpetic Neuralgia	273	(2)
Sciatica	275	(1)
Skin Ulcers	275	(1)
Tendonitis	276	(1)
Trigeminal Neuralgia	277	(1)
Visceral Pain	277	(2)
Appendix. Drug Interactions	279	(18)
Glossary	297	(4)
Index	301