Pain in the elderly

  • • Pain in the elderly may be due to one or more pain relief. Determining the cause of treatment is the most important step.

  • • Many social, cognitive, emotional and organic causes contribute to the formation of the pain clinic. Besides, the effects of pain aging, accompanying diseases, changes in mental status, depression, functional deficiencies, drug and alcohol habits should be taken into account in the evaluation of pain.

  • • The pain should be defined by the character of the pain (duration, intensity, frequency, localization, increasing and decreasing factors), definition of pain, effect of daily life activity and social life. In addition, treatments that have already been applied should be considered.

  • • Scales such as visual analogue scale (VAS), numerical evaluation scale, verbal evaluation scale, facial expression scale can be used in evaluation of pain severity and follow-up of treatment.

  • • Patients should be examined and the causes of pain should be found, the necessary imaging methods and laboratory techniques should be used for this purpose.

  • • All treatment options should be audited and patients appropriate for the patient should be identified and directed to the patients.

  • • Treatment options can be classified as pharmacological, non-pharmacological, minimally invasive and surgical methods. Appropriate treatment of patients is often performed by their application in steps or in the field.

  • Non-pharmacological methods include patient education, changes in activities of daily living, exercises, physical therapy and rehabilitation treatment methods, and psychotherapy.

  • • Pharmacological methods can be grouped into three groups as non opioid, opioid and adjuvant treatments. The World Health Organization recommends that these groups be used at regular time intervals, in accordance with the three-step ladder principle, at a personalized dose, orally, by controlling side effects and informing the patient. In 1986, World Health Organization recommended nonopioids in gore, mild-severe pain, weak opioids in moderate-intensity pain, and strong opioids in severe pain (Figure 1). Invasive procedures can be planned for patients who are resistant to these treatments and develop side effects that can not be controlled. Early application of invasive procedures should be considered to provide more effective analgesia with fewer side effects. Pharmacotherapy should be given to all these steps as an alternative or an adjunct, if practicable.

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Prof. Dr. Altan Şahin, 2018