Introduction
Accurate pain evaluation is the fundamental principle of proper pain control. With advancing age, some older people may have higher pain thresholds and pain tolerance resulting in slow response and misperception of intensity (Booker et al., 2016). To add, older patients are vulnerable to drugs and adverse reactions due to cardiac issues, hepatic and renal malfunction, decreased body water, and altered absorption (Booker & Haedtke, 2016). Accurate pain evaluation includes recognizing behavioral response: facial expressions, vocal complaints, changes in usual routines, mental changes (Hogans & Barreveld, 2020). Some patients over 65 consider pain to be a necessary part of their life at this age (Godwal et al., 2020). Fear of painful testings leads to denying pain as well (Hogans & Barreveld, 2020). In the case of elderly patients, correct evaluating prevents unnecessary endurance and improves functional and psychological ability.
Nonsteroidal anti-inflammatory drugs are often prescribed to reduce pain. The most common of them are aspirin (71 % of all NSAIDS prescribed) and Diclofenac (25%) (Czarnecki et al., 2018). NSAIDs are especially dangerous for the elderly, taking the factors listed above into consideration, as they cause different adverse reactions (Al-Azayzih et al., 2020). The list of such effects may include renal failure, gastrointestinal bleeding, cardiovascular dysfunction (Sezen, 2019). Therefore, alternative medications are to be considered in older adults’ treatment and care.
Case Study
Managing metastatic pain is an essential part of elderly treatment as it contributes to the geriatric quality of life. According to WHO (World Health Organization), metastatic pain is treated with analgesics in three successive steps: NSAIDS for minor pain, mild, then strong opiates for sharp pain. However, as stated above, older people are susceptible to side effects from NSAIDs and opioids can perform successfully with appropriate dosages, as modern pharmacodynamics studies show (Ahmad et al., 2018). The patient Bob can self-report, for he has had an active lifestyle before pain aroused; thus, based on his feelings, it is clear that the pain increased for the past week. Such type of pain is to be treated with opioids.
The safe use of opioids is debatable, yet, the correct dosing may be beneficial. A decrease in pain was proved for patients taking opioids in 65% of the cases by El Hachem et al. (2019). Another 45% of patients suffered from adverse reactions, including poor metabolism, urinary retention, nausea, and mental issues (El Hachem et al., 2019). The side effects of this kind could be easily eliminated if they were treated appropriately. For mild or sharp pain management, opioids can be of help. Buprenorphine, among others, proved to be the safest with a single agent that helps to avoid polypharmacy and addiction (El Hachem et al., 2019). Besides, the medication possesses an anti-depressive effect and can be used for patients with renal failure (Kennedy-Malone et al., 2019). The recommended dosing for onset equals 5 mcg per hour every three or four days.
The patient and his family should be informed about possible side effects and urged to report any changes. The pain is intense such opioids at a low dose that equals 30 – 50 % of an adult dose as morphine, oxycodone, and hydromorphone can help (Kennedy-Malone et al., 2019). Constant pain might be a factor more apt to cause cognitive impairments than opioids (Ahmad et al., 2018). On the whole, pain took under control and its relief improve the patient’s psychological well-being and guarantees the maintenance of the quality of life.
References
Ahmad, I., Ahmed, M. M., Ahsraf, M. F., Naeem, A., Tasleem, A., Ahmed, M., & Farooqi, M. S. (2018). Pain management in metastatic bone disease: A literature review. Cureus, 10(9), 9. Web.
Al-Azayzih, A., Al-Azzam, S. I., Alzoubi, K. H., Jarab, A. S., Kharaba, Z., Al-Rifai, R. H., & Alnajjar, M. S. (2020). Nonsteroidal anti-inflammatory drugs utilization patterns and risk of adverse events due to drug-drug interactions among elderly patients: A study from Jordan. Saudi Pharmaceutical Journal, 28(4), 504-508. Web.
Booker, S. S., Bartoszczyk, D. A., & Herr, K. A. (2016). Managing pain in frail elders. American nurse today, 11(4), 1-14. Web.
Booker, S. Q., & Haedtke, C. (2016). Evaluating pain management in older adults. Nursing2016, 46(6), 66-69. Web.
Czarnecki, M. L., Turner, H. N., & American Society For Pain Management Nursing. (2018). Core curriculum for pain management nursing. Elsevier.
El Hachem, G., Rocha, F. O., Pepersack, T., Jounblat, Y., Drowart, A., & Dal Lago, L. (2019). Advances in pain management for older patients with cancer. Ecance Medical Science, 13(1), 980-994. Web.
Godwal, K., Asija, R., & Khanijau, R. (2020). Monitoring of Non Steroidal Anti-Inflammatory drugs (NSAIDs) and use of proton pump inhibitors (PPIs) along with NSAIDS in elderly patients. International Journal of All Research Writings, 2(1), 58-64. Web.
Hogans, B. B., & Barreveld, A. M. (2020). Pain care essentials. Oxford University Press.
Kennedy-Malone, L., Lori Martin Plank, & Evelyn Groenke Duffy. (2019). Advanced practice nursing in the care of older adults. F.A. Davis Company.
Sezen, G. (2019). Polypharmacy in elders. Proceedings of the 6th Anesthesiology and Reanimation Specialist’s Society Congress. ARUD.
World Health Organization. (n.d.) WHO’s cancer pain ladder for adults. Web.