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Khurana A, Mahdi L, Wie C, Strand NH. Age and pain: are pain management clinicians keeping up with the increasing Medicare population? Reg Anesth Pain Med 2024:rapm-2023-104556. [PMID: 38599787 DOI: 10.1136/rapm-2023-104556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/07/2024] [Indexed: 04/12/2024]
Affiliation(s)
| | - Layth Mahdi
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, Arizona, USA
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2
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Lam N, Green J, Hallas S, Forster A, Crocker TF, Andre D, Ellwood A, Clegg A, Brown L. Mapping review of pain management programmes and psychological therapies for community-dwelling older people living with pain. Eur Geriatr Med 2024; 15:33-45. [PMID: 37853269 PMCID: PMC10876761 DOI: 10.1007/s41999-023-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Persistent pain is common in older people and people living with frailty. Pain or the impact of pain on everyday life is potentially modifiable. We sought to map research evidence and information from randomised controlled trials (RCTs) of pain management programmes and psychological therapies targeting community-dwelling older people, and explore appropriate strategies and interventions for managing or reducing the negative impact of pain for older people, particularly those with frailty. METHOD A mapping review of pain management programmes and psychological therapies for community-dwelling older people living with chronic pain. We searched for systematic reviews of randomised controlled trials and for individual randomised controlled trials and extracted data from eligible studies. RESULTS Searches resulted in 3419 systematic review records and 746 RCT records from which there were 33 eligible interventions identified in 31 eligible RCTs (48 reports). Broad aims of the interventions were to: improve physical, psychological, or social functioning; adjust the effects or sensation of pain psychologically; enhance self-care with self-management skills or knowledge. Common mechanisms of change proposed were self-efficacy enhanced by self-management tasks and skills, using positive psychological skills or refocusing attention to improve responses to pain, and practising physical exercises to improve physiological well-being and reduce restrictions from pain. Content of interventions included: skills training and activity management, education, and physical exercise. Interventions were delivered in person or remotely to individuals or in groups, typically in 1-2 sessions weekly over 5-12 weeks. CONCLUSION All the evaluated interventions appeared to show potential to provide some benefits to older people. None of the included studies assessed frailty. However, some of the included interventions appear appropriate for community-dwelling older people living with both frailty and pain.
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Affiliation(s)
- Natalie Lam
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Health Sciences, University of York, York, UK
| | - John Green
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sarah Hallas
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
- University of Leeds, Leeds, UK.
| | | | - Alison Ellwood
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
- University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
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Amodeo G, Franchi S, D’Agnelli S, Galimberti G, Baciarello M, Bignami EG, Sacerdote P. Supraspinal neuroinflammation and anxio-depressive-like behaviors in young- and older- adult mice with osteoarthritis pain: the effect of morphine. Psychopharmacology (Berl) 2023; 240:2131-2146. [PMID: 37530884 PMCID: PMC10506934 DOI: 10.1007/s00213-023-06436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
RATIONALE Asteoarthritis (OA) is a leading cause of chronic pain in the elderly population and is often associated with emotional comorbidities such as anxiety and depression. Despite age is a risk factor for both OA and mood disorders, preclinical studies are mainly conducted in young adult animals. OBJECTIVES Here, using young adult (11-week-old) and older adult (20-month-old) mice, we evaluate in a monosodium-iodoacetate-(MIA)-induced OA model the development of anxio-depressive-like behaviors and whether brain neuroinflammation may underlie the observed changes. We also test whether an effective pain treatment may prevent behavioral and biochemical alterations. METHODS Mechanical allodynia was monitored throughout the experimental protocol, while at the end of protocol (14 days), anxio-depressive-like behaviors and cognitive dysfunction were assessed. Neuroinflammatory condition was evaluated in prefrontal cortex, hippocampus and hypothalamus. Serum IFNγ levels were also measured. Moreover, we test the efficacy of a 1-week treatment with morphine (2.5 mg/kg) on pain, mood alterations and neuroinflammation. RESULTS We observed that young adult and older adult controls (CTRs) mice had comparable allodynic thresholds and developed similar allodynia after MIA injection. Older adult CTRs were characterized by altered behavior in the tests used to assess the presence of depression and cognitive impairment and by elevated neuroinflammatory markers in brain areas compared to younger ones. The presence of pain induced depressive-like behavior and neuroinflammation in adult young mice, anxiety-like behavior in both age groups and worsened neuroinflammation in older adult mice. Morphine treatment counteracted pain, anxio-depressive behaviors and neuroinflammatory activation in both young adult and older adult mice. CONCLUSIONS Here, we demonstrated that the presence of chronic pain in young adult mice induces mood alterations and supraspinal biochemical changes and aggravates the alterations already evident in older adult animals. A treatment with morphine, counteracting the pain, prevents the development of anxio-depressive disorders and reduces neuroinflammation.
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Affiliation(s)
- Giada Amodeo
- Dipartimento Di Scienze Farmacologiche E Biomolecolari, University of Milan, Via Vanvitelli 32, 20129 Milano, Italy
| | - Silvia Franchi
- Dipartimento Di Scienze Farmacologiche E Biomolecolari, University of Milan, Via Vanvitelli 32, 20129 Milano, Italy
| | - Simona D’Agnelli
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giulia Galimberti
- Dipartimento Di Scienze Farmacologiche E Biomolecolari, University of Milan, Via Vanvitelli 32, 20129 Milano, Italy
| | - Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Paola Sacerdote
- Dipartimento Di Scienze Farmacologiche E Biomolecolari, University of Milan, Via Vanvitelli 32, 20129 Milano, Italy
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Chopra S, Kodali RT, McHugh GA, Conaghan PG, Kingsbury SR. Home-Based Health Care Interventions for People Aged 75 Years and Above With Chronic, Noninflammatory Musculoskeletal Pain: A Scoping Review. J Geriatr Phys Ther 2023; 46:3-14. [PMID: 36525074 DOI: 10.1519/jpt.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Chronic, noninflammatory musculoskeletal pain is common in the aged population and management can be challenging for older people due to multimorbidity, social isolation, and physical frailty. The aim of this scoping review is to summarize and discuss the evidence related to home-based health care interventions for older adults, with chronic, musculoskeletal pain. METHODS A review of the literature using 8 electronic databases (Embase, MEDLINE, CINAHL, PubMed, Cochrane Library, Physiotherapy Evidence Database [PEDro], Scopus, and Web of Science) was performed, following the PRISMA-ScR guidelines. English language published studies that assessed home-based health care intervention/s, in men and women 75 years and older, with chronic, noninflammatory musculoskeletal pain where included. Two authors independently reviewed the articles and extracted data into a preformulated chart. RESULTS AND DISCUSSION The database search identified 4722 studies of which 7 studies met the inclusion criteria. Six of the 7 studies were randomized controlled trials and 5 studies focused on a single-site pain. The type of home-based interventions in the included studies was physical therapy (n = 2), psychotherapy (n = 3), and multimodal therapy (combination of multiple therapies) (n = 2). Participation completion rate was more than 74% in 6 out of 7 studies. Most studies used pain and/or physical function as their primary outcome (n = 6). Music therapy showed a statistically significant reduction in visual analog scale score for pain, and there was a trend toward improvement of pain and function in the physical therapy studies. No significant differences in outcomes between intervention and control groups were observed in the multimodal studies. CONCLUSION This review highlights the scarcity of evidence related to home-based health interventions in older people 75 years and older, living with chronic, noninflammatory musculoskeletal pain. The findings were that physical, psychotherapeutic, and multimodal interventions are usually well tolerated and can be delivered as a safe self-management option. There remains a substantial need for more high-quality research with wider range of home-based interventions and comprehensive assessment of outcomes for this age group.
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Affiliation(s)
- Swati Chopra
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
| | - Rama T Kodali
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
| | - Gretl A McHugh
- School of Healthcare, University of Leeds, Leeds, England
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
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Drewniok N, Mörgeli R, Eckardt-Felmberg R. Frailty-Diagnostik in verschiedenen AINS-Settings. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:682-696. [DOI: 10.1055/a-1760-8228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Das Vorliegen eines sog. Frailty-Syndroms („Gebrechlichkeit“) ist für den postoperativen Verlauf ein entscheidender Faktor. So kommt es, auch durch eine zunehmende Fokussierung auf die
patientenzentrierte Versorgung, zu einer erhöhten Nachfrage nach Instrumenten, die den Patient*innenstatus umfassender beurteilen und Krankheitsverläufe vorhersagen können. Der Beitrag
stellt die 3 führenden Modelle zur Frailty-Diagnostik vor.
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Friendship in Later Life: How Friends Are Significant Resources in Older Persons' Communication about Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095551. [PMID: 35564945 PMCID: PMC9103645 DOI: 10.3390/ijerph19095551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article focuses on how older persons perceive their friends' role in their daily experience of chronic pain. It reports part of the results of a study in which we interviewed 49 participants, aged 75 and older, about the way they communicate about chronic pain within their social network. METHODOLOGY Using discourse and content analysis, we first examine older persons' definition of friendship, and then identify the various dimensions of friendship that are engaged in the communication about chronic pain. RESULTS Participants define close friends as people with whom they share intimacy and social proximity (same gender, age and experience of pain). These dimensions allow older persons to talk freely about their pain without the fear of being judged or rejected, particularly when it is related to a dynamic of reciprocity. CONCLUSIONS This article shows that the contribution of friends to the everyday life of older persons with chronic pain is mainly that of providing emotional support.
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Merminod G, Weber O, Semlali I, Terrier A, Decosterd I, Rubli Truchard E, Singy P. Talking about chronic pain in family settings: a glimpse of older persons’ everyday realities. BMC Geriatr 2022; 22:358. [PMID: 35461217 PMCID: PMC9034600 DOI: 10.1186/s12877-022-03058-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The expression of chronic pain remains a delicate matter for those older persons who suffer from this condition. If many studies highlight the difficulties of putting pain into words, scarce are those that take into account how given social networks can facilitate or prevent its expression. Based on a qualitative study that explores the communication about chronic pain in older persons’ social network, this article reports on this key issue of talking about health in later life within family settings and provides clinicians with information about the way older persons with chronic conditions perceive their everyday realities and social relations.
Methods
A multidisciplinary research team (medicine, linguistics and psychology) interviewed 49 persons with chronic pain, all from the French-speaking part of Switzerland, aged 75 and older, without any major cognitive or auditory impairments. After transcription, the interviews were analyzed by combining content and discourse analysis with social network theories.
Results
Communication about chronic pain depends significantly on the position of the interlocutors within the family structure, with a preference for direct relatives or individuals with similar difficulties. In social networks, the ability to communicate about chronic pain is both a resource (by allowing older persons to get help or by strengthening interpersonal relations) and a challenge (by threatening their autonomy, social relations or self-esteem).
Conclusions
The study shows the predominance of the nuclear family (partner, children) in communication relating specifically to the everyday management of chronic pain. This state of affairs is, nevertheless, balanced by issues of (loss of) autonomy. These findings, in line with current trends in geriatrics, could benefit future reflections on the scope and limits of including relatives in the care of older patients with chronic conditions.
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D'Agnelli S, Amodeo G, Franchi S, Verduci B, Baciarello M, Panerai AE, Bignami EG, Sacerdote P. Frailty and pain, human studies and animal models. Ageing Res Rev 2022; 73:101515. [PMID: 34813977 DOI: 10.1016/j.arr.2021.101515] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/01/2022]
Abstract
The hypothesis that pain can predispose to frailty development has been recently investigated in several clinical studies suggesting that frailty and pain may share some mechanisms. Both pain and frailty represent important clinical and social problems and both lack a successful treatment. This circumstance is mainly due to the absence of in-depth knowledge of their pathological mechanisms. Evidence of shared pathways between frailty and pain are preliminary. Indeed, many clinical studies are observational and the impact of pain treatment, and relative pain-relief, on frailty onset and progression has never been investigated. Furthermore, preclinical research on this topic has yet to be performed. Specific researches on the pain-frailty relation are needed. In this narrative review, we will attempt to point out the most relevant findings present in both clinical and preclinical literature on the topic, with particular attention to genetics, epigenetics and inflammation, in order to underline the existing gaps and the potential future interventional strategies. The use of pain and frailty animal models discussed in this review might contribute to research in this area.
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Merminod G, Weber O, Vaucher C, Semlali I, Terrier A, Decosterd I, Rubli Truchard E, Singy P. Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach. Front Public Health 2021; 9:764584. [PMID: 34805077 PMCID: PMC8595239 DOI: 10.3389/fpubh.2021.764584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.
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Affiliation(s)
- Gilles Merminod
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Orest Weber
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Carla Vaucher
- Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Imane Semlali
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Anamaria Terrier
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Decosterd
- Pain Center, Service of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Geriatrics and Geriatric Rehabilitation Service and Chair of Geriatric Palliative Care, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Khalighi E, Ghiasi G, Karimi E, Borji M, Salimi E, Tarjoman A, Solaimanizadeh L. Assessment of Mental Health Elderly with Chronic Pain Based on Quranic Components. JOURNAL OF RELIGION AND HEALTH 2020; 59:2807-2818. [PMID: 31493215 DOI: 10.1007/s10943-019-00908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Considering the presence of mental disorders during illness or old age, it is necessary to pay attention to the mental health of the elderly. A modeling of the God's attributes means that one understands God's perception of his/her existential poverty; and on the other hand, one endeavors to work in the human domain in order to replicate and utilize the names and attributes of God the Almighty. For this reason, this study aims to determine the mental health (MH) assessment of elderly people with chronic pain (CP) based on Quranic components. The study is a descriptive cross-sectional study. A total of 138 elderly people who are aged over 65 years and had history of CP were enrolled. Data were collected using Islamic Questionnaire of Identifying God's Traits in the same, and analysis was performed using SPSS ver. 16. The mean (SD) of age in elderly is 81.00 (12.07), and as the age increased, the God's Traits score of the elderly increased (p = 0.003, R = 0.34). The mean overall God's Traits score was 234.68 (3.61). In the elderly who lived with their spouse and had higher social support, the score of God's Traits was higher (p > 0.05), but there was no relationship between other demographic characteristics and status of God's Traits (p > 0.05). This study is the first study to evaluate the MH status of chronic patients based on Quranic components, and their MH status has been high. It is suggested that the relationship between MH based on Quranic components and variables related to health be measured.
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Affiliation(s)
- Ebrahim Khalighi
- Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science, Ilam, Islamic Republic of Iran
| | - Gholamreza Ghiasi
- Islamic Education School of Medicine, Ilam University of Medical Science, Ilam, Islamic Republic of Iran
| | - Ehsan Karimi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Science, Kermanshah, Islamic Republic of Iran
| | - Ebrahim Salimi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Science, Ilam, Islamic Republic of Iran
| | - Asma Tarjoman
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Islamic Republic of Iran
| | - Laleh Solaimanizadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Bam University of Medical Science, Bam, Islamic Republic of Iran.
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Pask S, Dell'Olio M, Murtagh FEM, Boland JW. The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic Review. J Pain Symptom Manage 2020; 59:871-893.e1. [PMID: 31678462 DOI: 10.1016/j.jpainsymman.2019.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023]
Abstract
CONTEXT Opioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment. OBJECTIVES To identify, appraise, and synthesize evidence on the impact of opioids on cognition in older adults with cancer/chronic noncancer pain, and screening tools/neuropsychological assessments used to detect opioid-induced cognitive impairment. METHODS A systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (international prospective register of systematic reviews registration: CRD42018092943). MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science were searched up to December 2018. Randomized controlled trials, quasi-experimental studies, and observational studies of adults aged 65 years and older with cancer/chronic noncancer pain taking opioids were included. A narrative synthesis was conducted. RESULTS From 4036 records, 10 met inclusion criteria. Five studies used one screening tool, and five studies used a range of neuropsychological assessments; assessing 14 cognitive domains. Most studies demonstrated no effect of opioid use on cognitive domains, whereas four studies showed mixed effects. In particular, attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory were worsened. Changes to cognitive function were predominantly observed in studies with higher mean doses of opioids (120-190.7mg oral morphine equivalent daily dose). CONCLUSION Both improvements and impairments to cognition were observed in studies with higher mean opioid doses. In clinical practice, a brief screening tool assessing attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory may be beneficial to detect worsening cognition in older adults with chronic pain using opioids.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Myriam Dell'Olio
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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13
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Hagen M, Alchin J. Nonprescription drugs recommended in guidelines for common pain conditions. Pain Manag 2020; 10:117-129. [DOI: 10.2217/pmt-2019-0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Evidence-based pain guidelines allow recommendation of nonprescription analgesics to patients, facilitating self-care. We researched clinical practice guidelines for common conditions on websites of pain associations, societies, health institutions and organizations, PubMed, ProQuest, Embase, Google Scholar until April 2019. We wanted to determine whether there is a consensus between guidelines. From 114 identified guidelines, migraine (27) and osteoarthritis (26) have been published most around the world, while dysmenorrhea (14) is mainly discussed in developing countries. Specific recommendations to pregnant women, children and older people predominantly come from the UK and USA. We found that acetaminophen and oral nonsteroidal anti-inflammatory drugs (NSAIDs) represent first-line management across all pain conditions in adults and children. In osteoarthritis, topical NSAIDs should be considered before oral NSAIDs. This knowledge might persuade patients that using these drugs first could enable fast and effective pain relief.
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Affiliation(s)
| | - John Alchin
- Pain Management Centre, Burwood Hospital, Christchurch, New Zealand
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14
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Guerriero F, Reid MC. Linking Persistent Pain and Frailty in Older Adults. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:61-66. [PMID: 31343692 PMCID: PMC7999618 DOI: 10.1093/pm/pnz174] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In older adults, the impact of persistent pain goes beyond simple discomfort, often contributing to worsening functional outcomes and ultimately frailty. Frailty is a geriatric syndrome that, like persistent pain, increases in prevalence with age and is characterized by a decreased ability to adapt to common stressors such as acute illness, thereby increasing risk for multiple adverse health outcomes. Evidence supports a relationship between persistent pain and both the incidence and progression of frailty, independent of health, social, and lifestyle confounders. DESIGN AND SETTING In this article, we synthesize recent evidence linking persistent pain and frailty in an effort to clarify the nature of the relationship between these two commonly occurring geriatric syndromes. SETTING We propose an integration of the frailty phenotype model by considering the impact of persistent pain on vulnerability toward external stressors, which can ultimately contribute to frailty in older adults. RESULTS AND CONCLUSIONS Incorporating persistent pain into the frailty construct can help us better understand frailty and ultimately improve care for patients with, as well as those at increased risk for, pain and frailty.
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Affiliation(s)
- Fabio Guerriero
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - M C Reid
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Backhaus I, Mannocci A, La Torre G. A Systematic Review of Economic Evaluation Studies of Drug-Based Non-Malignant Chronic Pain Treatment. Curr Pharm Biotechnol 2019; 20:910-919. [PMID: 31322067 DOI: 10.2174/1389201020666190717095443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic pain is a highly prevalent problem, involving high costs and seriously affecting a patient's quality of life. This review aimed to systematically review economic evaluations of pharmacological-based treatments for non-malignant chronic pain and to compare different treatment approaches with regard to their economic profile. METHODS PubMed and Scopus were systematically searched in April 2016. Studies were included if quality-adjusted life years and incremental cost-effectiveness ratios were reported. Quality assessment was carried out by using La Torre's weighted scale on the Drummond checklist. Costs were converted into US$2014. RESULTS Fourteen economic evaluations met the inclusion criteria. Three treatment categories identified were: opioids, anticonvulsants, and anti-depressants. Compared to anticonvulsants and antidepressant, opioids had lower ICER. Transdermal buprenorphine showed an ICER of about US$11,000.00 while pregabalin showed an ICER of US$19,200. Studies included showed a diversity of methodological approaches, such as different modeling approaches and different perspectives (NHS and private payer). CONCLUSION There are limitations to the success of making appropriate recommendations about which treatment is most cost-effective due to considerable variability between treatments, pain syndromes, and drug dosages. Opioids may have lower ICER, but the societal implications of the opioid epidemic and overdose deaths should be taken into account when coming to general conclusions about their cost-effectiveness. To ensure correct resource allocation as well as the best benefit for patients, uniform and standardized approaches of cost and outcome measurement in economic evaluations of chronic are needed.
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Affiliation(s)
- Insa Backhaus
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Alice Mannocci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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Leopoldino AAO, Megale RZ, Diz JBM, Moreira BDS, Lustosa LP, Pereira LSM, Ferreira ML. Influence of the number and severity of comorbidities in the course of acute non-specific low back pain in older adults: longitudinal results from the Back Complaints in the Elders (BACE-Brazil). Age Ageing 2019; 49:96-101. [PMID: 31665205 DOI: 10.1093/ageing/afz134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/16/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The presence of comorbidities is quite common in older adults. However, the effects of comorbidities on the course of acute low back pain (LBP) are not fully understood. OBJECTIVE To investigate the effects of the number and severity of comorbidities on the severity of pain and disability 3 months from baseline in people with an acute episode of non-specific LBP. METHODS Data from the Back Complaints in the Elders study, a cohort that enrolled 602 community-dwelling older adults with acute LBP at baseline, were used in these analyses. Comorbidities, pain intensity and disability were assessed using the Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. Age, sex, marital status, education, income and body mass index were covariates. RESULTS The mean age of participants was 67.6 ± 7.0 years. Both pain and disability scores decreased from 7.2 (95% confidence interval [95% CI] 7.0-7.4) to 5.8 (95% CI 5.5-6.1) in NRS and from 13.5 (95% CI 13.0-14.1) to 12.0 (95% CI 11.4-12.7) in RMDQ 3 months from baseline. The linear regression analysis showed a significant association between SCQ scores at baseline and pain (coefficient = 0.16, 95% CI 0.08-0.24; P < 0.001) or disability (coefficient = 0.29, 95% CI 0.16-0.41; P < 0.001) scores at the 3-month follow-up, after adjusting for confounders. Participants with highest SCQ scores were less likely to report improvement of at least 30% in pain (OR: 0.41, 95% CI 0.22-0.79; P = 0.008) and disability (OR: 0.42, 95% CI 0.28-0.85; P = 0.015). CONCLUSION The presence and severity of comorbidities were independently associated with the prognosis of acute non-specific LBP in older adults.
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Affiliation(s)
- Amanda Aparecida Oliveira Leopoldino
- Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Juliano Bergamaschine Mata Diz
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruno de Souza Moreira
- Graduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lygia Paccini Lustosa
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leani Souza Máximo Pereira
- Department of Physical Therapy, Graduate Program in Rehabilitation Science, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Manuela Loureiro Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Bantel C, Hoffmann F, Jobski K. Pain And The Use Of Gabapentinoids In German Nursing Home Residents - Results From An Analysis Based On Statutory Health Insurance Data. J Pain Res 2019; 12:3175-3184. [PMID: 31819602 PMCID: PMC6878919 DOI: 10.2147/jpr.s221579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/03/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gabapentinoids (gabapentin and pregabalin) are psychoactive medications that are increasingly used for different conditions. Since there is evidence that psychotropic drugs, in general, are often inappropriately prescribed in elderly patients, we aimed to determine frequency and indications of gabapentinoid prescribing for nursing home residents. METHODS We analyzed data from a large German statutory health insurance database. Included were records from people ≥65 years-of-age, who were admitted to a nursing home between January 2010 and December 2014. We determined the number and proportion of common indications for on- and off-label prescriptions, the most frequent co-medications, and the characteristics of patients and prescribers. RESULTS Of 127,277 residents, 9539 (7.5%) received gabapentinoids and 4852 initiated treatment (4.0%; with 66.3% pregabalin). Median age of gabapentinoid initiators was 84 years (78.5% females). In these users, on-label prescribing was found in 57.4%, predominantly for neuropathic pain. Other painful conditions were also chief causes (84.7%) for off-label prescribing. Gabapentinoids were mainly started by general practitioners (64.5%) while pain specialists contributed <2%. Forty-six percent of users received additional opioids and in 27.5% gabapentinoids were prescribed only once. CONCLUSION Gabapentinoids were frequently used in nursing home residents. Regular co-prescribing with opioids and psychotropic drugs might indicate employment to improve pain or assist treatment of conditions that are frequently associated with disruptive behavior such as dementia. However, more research is needed to better understand decision-making regarding gabapentinoid prescribing, especially in view of aggressive marketing, uncertain analgesic effects, problematic side effects, and uncritical use in the elderly.
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Affiliation(s)
- C Bantel
- Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Universität Oldenburg, Klinikum Oldenburg, Oldenburg, Germany
- Department of Surgery & Cancer, Anaesthetics Section, Imperial College London, London, UK
| | - F Hoffmann
- Department of Health Services Research, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - K Jobski
- Department of Health Services Research, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
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Campos HLM, Liebano RE, Lima CA, Perracini MR. Multidimensional investigation of chronic pain experience and physical functioning following hip fracture surgery: clinical implications. Br J Pain 2019; 14:5-13. [PMID: 32110393 DOI: 10.1177/2049463719861994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Older adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities. Methods We conducted a cross-sectional study of 50 older adults (77.1 ± 8.1 years old) who underwent hip fracture surgery in the past 4 months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire. Results Participants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5 ± 1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability (r = -0.41, p < 0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB (r = -0.41, p < 0.01), and the evaluative category was moderately correlated to ADL and IADL disability (r = 0.43, p < 0.01). Conclusion Pain can be present 4 months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.
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Affiliation(s)
| | - Richard Eloin Liebano
- Universidade Cidade de São Paulo, São Paulo, Brazil.,Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | | | - Monica Rodrigues Perracini
- Universidade Cidade de São Paulo, São Paulo, Brazil.,Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
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Kirubakaran S, Dongre AR. Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study. J Family Med Prim Care 2019; 8:77-85. [PMID: 30911484 PMCID: PMC6396588 DOI: 10.4103/jfmpc.jfmpc_290_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives (1) To determine the prevalence of chronic pain of musculoskeletal origin at different body sites among elderly (≥60 years). (2) To study the determinants of chronic pain and the healthcare seeking behavior among elderly with chronic pain. (3) To explore the perceptions of chronic pain among elderly. Materials and Methods This study was done in 55 field practice villages of the Rural Health Training Centre (RHTC) of the Department of Community Medicine, SMVMCH, Puducherry. An Exploratory Mixed-Method study design, where a qualitative phase (in-depth interviews [IDI]) followed the quantitative phase (Survey). A representative sample of 850 respondents was selected by two-stage cluster sampling. A trained investigator did a house-to-house visit and interviewed selected elderly respondents by using predesigned and pretested questionnaire. The intensity of chronic pain was measured using the Functional Rating Scale and Numeric Rating Scale. The manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. Results Qualitative data were described under two broad themes: (1) perceptions of elderly people about chronic pain and 2) healthcare seeking and coping mechanisms. Prevalence of chronic pain among the elderly respondents was found to be 47.6%. Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). Most of the older people with chronic pain had mild-to-moderate and tolerable pain. Two predictors for chronic pain were the age of the respondent (adjusted OR -1.03, 95% CI = 1.01-1.05) and the presence of at least one chronic morbidity (adjusted OR -1.37, 95% CI = 1.03-1.82). Conclusions and Recommendations Since the chronic pain was found to be associated with aging and the presence of at least one of the chronic morbidities, it is crucial for treating community physicians to consider the comorbid conditions while managing chronic pain in elderly. Considering the complex nature of chronic pain in old age, the primary care physician should be trained in drug and context-specific nondrug interventions to address the biomedical causes and other cognitive-behavior factors, respectively, through active support from their family and neighborhood.
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Affiliation(s)
- S Kirubakaran
- Department of Community Medicine, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
| | - Amol R Dongre
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India
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Rastogi R, Pearson A, Wikle J. Pain in Older Adults. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim JY, Kim JH, Yee J, Song SJ, Gwak HS. Risk factors of opioid-induced adverse reactions in elderly male outpatients of Korea Veterans Hospital. BMC Geriatr 2018; 18:293. [PMID: 30486785 PMCID: PMC6264622 DOI: 10.1186/s12877-018-0990-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/21/2018] [Indexed: 01/20/2023] Open
Abstract
Background Risk factors associated with opioid-induced adverse reactions (OIARs) in the elderly population have not been well defined. The objective of this study was to determine effects of various risk factors on incidence of OIARs in male elderly patients. Methods A retrospective cohort study in Korea Veterans Hospital was performed. Data were analyzed in male patients aged 65 years and older who received morphine, oxycodone, or codeine. Binomial variables describing patient-related and drug-related characteristics were constructed. Associations between these variables and frequency of OIARs were determined. Odds ratio (OR) and adjusted odds ratio (AOR) were calculated from univariate and multivariable analyses, respectively. Attributable risk was obtained by (1–1/OR)*100%. Results Of 316 patients, 28% experienced at least one adverse event. The most common adverse events were gastrointestinal problems (n = 59) and central nerve system adverse effects (n = 20). The odds of OIARs in patients with opioid use ≥12 weeks was increased by 80% compared to those with opioid use < 12 weeks. Attributable risk of GABA analogues was 64~78% in constructed Models. Compared to codeine users, patients using morphine and oxycodone had 653 and 473% increased odds for OIARs, respectively. MME ≥ 60 mg/day had a 317% increased odds for OIARs (95% CI: 1.92–9.04) compared to MME < 60 mg/day. Opioid combination therapy had a 139% increased odds for OIARs compared to monotherapy. Conclusions These findings have significant implications for clinical use of opioid in elderly patients. Our study suggests that low dose short-term use will pose less risk of OIARs for the elderly, whereas concomitant use of GABA analogues, strong opioids and dual-opioid therapy may increase the risk of OIARs. Therefore, clinician should carefully monitor patients when starting opioid therapy in older population.
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Affiliation(s)
- Ji Young Kim
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, 03760, South Korea.,Department of Pharmacy, Korea Veterans Hospital, Seoul, 05368, South Korea
| | - Joo Hee Kim
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil Seodaemun-gu, Seoul, 03760, Republic of Korea.,College of Pharmacy & Institute of Pharmaceutical Science and Technology, Ajou University, Suwon-si, 16499, South Korea
| | - Jeong Yee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Soo Jin Song
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, 03760, South Korea.,Department of Pharmacy, Korea Veterans Hospital, Seoul, 05368, South Korea
| | - Hye Sun Gwak
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, 03760, South Korea. .,College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil Seodaemun-gu, Seoul, 03760, Republic of Korea.
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Li Y, Huang K, Cheng Y, Tong Y, Mo J. Pain Management by Nurses in Level 2 and Level 3 Hospitals in China. Pain Manag Nurs 2018; 20:284-291. [PMID: 30425013 DOI: 10.1016/j.pmn.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/01/2018] [Accepted: 08/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain management practice differs among hospitals in China; however, no studies have examined the association between hospital level and nursing practice of pain management. AIMS To evaluate the nursing practice of pain management in orthopedics wards of level 3 and 2 hospitals and compare the differences in pain management regulations, policies, and perceived barriers. DESIGN This was a cross-sectional descriptive study. SETTING This study was conducted during the 10th International Congress of the Chinese Orthopedic Association, November 19-22, 2015. PARTICIPANTS Subjects: The sample included 121 nurses from China. METHODS Quantitative research methods were used to assess pain management practice by 121 Chinese nurses as well as barriers to nursing practice. RESULTS Nurses in level 3 hospitals were more likely to evaluate patients' pain intensity (85.23% vs. 65.38%, p < .05) and quality (77.27% vs. 53.85%, p < .05) than those in level 2 hospitals. Compared with level 2 hospitals, level 3 hospitals were more likely to participate in the Painless Orthopedics Ward program (53.41% vs. 23.08%, p < .01), conduct pain management knowledge training (88.64% vs. 69.23%, p < .05), and establish pain management regulations (68.18% vs. 34.62%, p < .01). Level 2 hospital nurses reported a higher score for barriers than level 3 hospital nurses (3.27 vs. 2.45, p < .05). CONCLUSIONS Nurses from level 2 hospitals received less education on pain management and also paid less attention to and faced more restrictions for pain management than nurses from level 3 hospitals.
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Affiliation(s)
- Yunxia Li
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kangmao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Cheng
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | - Jian Mo
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Saraiva MD, Suzuki GS, Lin SM, de Andrade DC, Jacob-Filho W, Suemoto CK. Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies. Age Ageing 2018; 47:785-793. [PMID: 30052700 DOI: 10.1093/ageing/afy104] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background pain is prevalent in frail older adults; however, the association of pain and frailty has not been evaluated yet by a systematic assessment of prospective longitudinal studies. Objective we aimed to assess the association of persistent pain as a risk factor for frailty incidence, using data from longitudinal studies in a systematic review and meta-analysis. Methods publications were identified using a systematic search on PubMed, Embase, Cochrane Library and clinicaltrials.gov databases from inception to October 2017. Since heterogeneity across studies was high, we used random-effects meta-analysis to calculate the pooled relative risk for the association between persistent pain and the incidence of frailty. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses. Results we included five prospective longitudinal studies with 13,120 participants (46% women, mean age from 59 to 85 years old). Participants with persistent pain at baseline had twice the risk of developing frailty during the follow-up (pooled RR = 2.22, 95% CI = 1.14-4.29). No variables were related to study heterogeneity in sensitivity analyses. Conclusion persistent pain was a risk factor for the development of frailty in a meta-analysis of longitudinal studies. Better understanding of the association between pain and frailty with proper evaluation of potential confounders could allow the development of targeted interventions.
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Affiliation(s)
- Marcos Daniel Saraiva
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, CEP, Brazil
| | - Gisele Sayuri Suzuki
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, CEP, Brazil
| | - Sumika Mori Lin
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, CEP, Brazil
| | | | - Wilson Jacob-Filho
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, CEP, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, CEP, Brazil
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Shahar I, Mendelson G, Gerbi S, Ben Natan M. Pain Assessment and Management by Nurses in a Geriatric Setting: Discrepancies between Guidelines and Documented Practice. Pain Manag Nurs 2018; 19:456-463. [DOI: 10.1016/j.pmn.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/26/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
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Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, Reid MC. Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:830-839. [PMID: 29801109 PMCID: PMC6145761 DOI: 10.1001/jamainternmed.2018.0756] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Chronic noncancer pain (hereafter referred to as chronic pain) is common among older adults and managed frequently with pharmacotherapies that produce suboptimal outcomes. Psychological treatments are recommended, but little information is available regarding their efficacy in older adults. OBJECTIVE To determine the efficacy of psychological interventions in older adults with chronic pain and whether treatment effects vary by participant, intervention, and study characteristics. DATA SOURCES MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from inception to March 29, 2017. STUDY SELECTION Analysis included studies that (1) used a randomized trial design, (2) evaluated a psychological intervention that used cognitive behavioral modalities alone or in combination with another strategy, (3) enrolled individuals with chronic pain (pain ≥3 months) with a sample mean age of 60 years or older, and (4) reported preintervention and postintervention quantitative data. DATA EXTRACTION AND SYNTHESIS Two of the authors independently extracted data. A mixed-model meta-analysis tested the effects of treatment on outcomes. Analyses were performed to investigate the association between participant (eg, age), intervention (eg, treatment mode delivery), and study (eg, methodologic quality) characteristics with outcomes. MAIN OUTCOMES AND MEASURES Pain intensity was the primary outcome; secondary outcomes included pain interference, depressive symptoms, anxiety, catastrophizing beliefs, self-efficacy for managing pain, physical function, and physical health. RESULTS Twenty-two studies with 2608 participants (1799 [69.0%] women) were analyzed. Participants' mean (SD) age was 71.9 (7.1) years. Differences of standardized mean differences (dD) at posttreatment were pain intensity (dD = -0.181, P = .006), pain interference (dD = -0.133, P = .12), depressive symptoms (dD = -0.128, P = .14), anxiety (dD = -0.205, P = .09), catastrophizing beliefs (dD = -0.184, P = .046), self-efficacy (dD = 0.193, P = .02), physical function (dD = 0.006, P = .96), and physical health (dD = 0.160, P = .24). There was evidence of effects persisting beyond the posttreatment assessment only for pain (dD = -0.251, P = .002). In moderator analyses, only mode of therapy (group vs individual) demonstrated a consistent effect in favor of group-based therapy. CONCLUSIONS AND RELEVANCE Psychological interventions for the treatment of chronic pain in older adults have small benefits, including reducing pain and catastrophizing beliefs and improving pain self-efficacy for managing pain. These results were strongest when delivered using group-based approaches. Research is needed to develop and test strategies that enhance the efficacy of psychological approaches and sustainability of treatment effects among older adults with chronic pain.
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Affiliation(s)
- Bahar Niknejad
- Department of Medicine, Eastern Virginia Medical School, Norfolk
| | - Ruth Bolier
- GERION, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Diana Delgado
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
| | - Elissa Kozlov
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Olivência SA, Barbosa LGM, Cunha MRD, Silva LJD. Pharmacological treatment of chronic non-malignant pain among elderly persons: an integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.170179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: The objective of the present study was to perform an integrative review of proposed pharmacological treatments for chronic non-malignant pain in elderly patients. Method: An integrative review was carried out. The search of literature included papers about the treatment of chronic pain among the elderly, published from 2007 to 2017 and available in Portuguese or English. Searches were conducted on the LILACS and MEDLINE electronic databases using the key words “chronic pain”, “treatment” and “elderly” combined with the Boolean operator “AND”. To analyse methodological quality, the adapted Critical Appraisal Skill Program (CASP) was used. Results: Of a total of 303 studies found, 32 were included. The articles selected included 20 reviews, five observational studies, five clinical trials, one case series and one retrospective study. A total of 75% of the articles were published in the last five years, of which one was in Portuguese and 31 in English. Conclusion :The results demonstrate a variety of treatments for chronic pain among the elderly population, highlighting the role of opioids which, according to more recent evidence, can be carefully used in treatment. Several drugs, however, have not been specifically tested for the elderly population. A number of factors are relevant in pain management of elderly patients, including comorbidities, polypharmacy and patient functionality. An individualized approach should be applied to elderly patients to improve outcomes and reduce side effects.
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Guevremont N, Barnes M, Haupt CE. Physician Autonomy and the Opioid Crisis. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:203-219. [PMID: 30146981 DOI: 10.1177/1073110518782922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.
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Affiliation(s)
- Nathan Guevremont
- Mark Barnes, J.D., LL.M., is a partner at Ropes & Gray, LLP, a Visiting Lecturer at Yale Law School and a Lecturer at the Yale School of Medicine. Nathan Guevremont is a student at Yale Law School, J.D. expected 2018; Claudia E. Haupt, Ph.D., J.S.D., is Resident Fellow, Information Society Project, and Research Fellow, Solomon Center for Health Law & Policy, both at Yale Law School
| | - Mark Barnes
- Mark Barnes, J.D., LL.M., is a partner at Ropes & Gray, LLP, a Visiting Lecturer at Yale Law School and a Lecturer at the Yale School of Medicine. Nathan Guevremont is a student at Yale Law School, J.D. expected 2018; Claudia E. Haupt, Ph.D., J.S.D., is Resident Fellow, Information Society Project, and Research Fellow, Solomon Center for Health Law & Policy, both at Yale Law School
| | - Claudia E Haupt
- Mark Barnes, J.D., LL.M., is a partner at Ropes & Gray, LLP, a Visiting Lecturer at Yale Law School and a Lecturer at the Yale School of Medicine. Nathan Guevremont is a student at Yale Law School, J.D. expected 2018; Claudia E. Haupt, Ph.D., J.S.D., is Resident Fellow, Information Society Project, and Research Fellow, Solomon Center for Health Law & Policy, both at Yale Law School
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Dentino A, Medina R, Steinberg E. Pain in the Elderly: Identification, Evaluation, and Management of Older Adults with Pain Complaints and Pain-related Symptoms. Prim Care 2018; 44:519-528. [PMID: 28797377 DOI: 10.1016/j.pop.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pain is a common and often underappreciated and undermanaged problem in older adults. This article addresses the scope of the issue of pain prevalence in older adults, types of pain and their characteristics, approach to and clinical workup of older adults with pain complaints and pain-related symptoms, nonpharmacologic and pharmacologic management strategies, and caveats with attention to medication side effects in the elderly.
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Affiliation(s)
- Andrew Dentino
- The Donald W. Reynolds Department of Geriatric Medicine, The University of Oklahoma Health Sciences Center College of Medicine, Oklahoma City, OK, USA.
| | - Roberto Medina
- The Donald W. Reynolds Department of Geriatric Medicine, The University of Oklahoma Health Sciences Center College of Medicine, Oklahoma City, OK, USA
| | - Eugene Steinberg
- The Donald W. Reynolds Department of Geriatric Medicine, The University of Oklahoma Health Sciences Center College of Medicine, Oklahoma City, OK, USA
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Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Multidimensional Frailty and Pain in Community Dwelling Elderly. PAIN MEDICINE 2018; 18:693-701. [PMID: 25800906 DOI: 10.1111/pme.12746] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity. Design Cross-sectional. Methods A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted. Results In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001). Conclusion Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.
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Affiliation(s)
- Tiago Coelho
- Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia, Portugal.,Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Constança Paúl
- Department of Behaviour Sciences, UNIFAI/ICBAS, University of Porto, Porto, Portugal
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental HealthCenter for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Kang Y, Demiris G. Self-report pain assessment tools for cognitively intact older adults: Integrative review. Int J Older People Nurs 2017; 13:e12170. [PMID: 28980440 DOI: 10.1111/opn.12170] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 08/21/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pain is common in older adults, but it is often underreported or undertreated partly because many consider pain to be a normal consequence of ageing. Among the plethora of available self-report pain assessment tools, there is no synthetised evidence which tools are indicated for use among cognitively intact older adults. PURPOSE OF THE STUDY To understand documented self-report pain assessment tools that have been used among cognitively intact older adults, and to describe their characteristics including overall performance as well as studies demonstrating their use. METHODS A systematic search of the indexed databases PubMed, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) was conducted to identify documented self-report pain assessment tools through peer-reviewed papers, including citations from January 1990 to December 2015. Thirty-five percentage of abstracts were independently evaluated by two raters according to specific criteria. RESULTS Among identified tools, the Iowa Pain Thermometer, the 6-point Verbal Descriptor Scale, the Numeric Rating Scale, the short form Brief Pain Inventory (BPI) and the Geriatric Pain Measure (GPM) may be suitable tools for self-reported pain by cognitively intact older adults based on the statement of the literature. Only two self-report tools (the GPM and the Geriatric Painful Events Inventory) were designed specifically for older adults. CONCLUSIONS More studies are needed to evaluate pain measures' psychometric performance across different settings, racial/ethnic groups and disease categories. Since 80% of older adults have at least one chronic disease, multidimensional tools such as the GPM may need to be used more often for accurate self-report of pain. IMPLICATIONS FOR PRACTICE Examining the psychometric properties of comprehensive self-report pain assessment tools informs recommendations for the selection of tools to be used in clinical practice.
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Affiliation(s)
- Youjeong Kang
- School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- School of Nursing & School of Medicine, University of Washington, Seattle, WA, USA
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The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0126-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rendina DN, Ryff CD, Coe CL. Precipitous Dehydroepiandrosterone Declines Reflect Decreased Physical Vitality and Function. J Gerontol A Biol Sci Med Sci 2017; 72:747-753. [PMID: 27470298 PMCID: PMC6074872 DOI: 10.1093/gerona/glw135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/05/2016] [Indexed: 01/20/2023] Open
Abstract
Dehydroepiandrosterone (DHEA) and its sulfated form, DHEA-S, peak in young adulthood and then decrease dramatically with age. However, there is extensive variation in this age-related hormone decline, suggesting an early decrement may be associated with lower vitality and be prognostic of poor health in old age. To determine whether DHEA-S and DHEA are correlated with physical indices of vitality, hormone levels were analyzed with respect to clinical health histories, physical functioning including grip strength, gait speed and repetitive standing, and self-reported chronic pain. The participants (N = 1,214) were 35-86 years of age from a nationally representative survey, Midlife Development in the United States. DHEA-S and DHEA below age-expected levels were associated with more chronic illness conditions and self-reported persistent pain and pain sensitivity upon manual palpation. Additionally, lower DHEA-S and DHEA correlated with poorer performance on tests of physical functioning by middle age suggesting a more precipitous decline is already indicative of reduced vigor and physical strength. When considered with respect to age- and gender-typical norms, larger decrements in DHEA-S and DHEA may be causally related to the loss of physical vitality. Conversely, when hormone secretion is sustained in older adults, it conveys reduced risk for the physical weakness and ailments that precede frailty.
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Affiliation(s)
| | - Carol D Ryff
- Institute of Aging, University of Wisconsin, Madison
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El Tumi H, Johnson M, Dantas P, Maynard M, Tashani O. Age-related changes in pain sensitivity in healthy humans: A systematic review with meta-analysis. Eur J Pain 2017; 21:955-964. [DOI: 10.1002/ejp.1011] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 01/30/2023]
Affiliation(s)
- H. El Tumi
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
- University of Benghazi; Benghazi Libya
| | - M.I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - P.B.F. Dantas
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
- Universidade Federal do Rio Grande do Norte; Natal Brazil
| | - M.J. Maynard
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
| | - O.A. Tashani
- Centre for Pain Research, School of Clinical and Applied Sciences; Leeds Beckett University; Leeds UK
- University of Benghazi; Benghazi Libya
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Morais DD, Terassi M, Inouye K, Luchesi BM, Pavarini SCI. Chronic pain in elderly caregivers at different levels of frailty. ACTA ACUST UNITED AC 2017; 37:e60700. [PMID: 28198946 DOI: 10.1590/1983-1447.2016.04.60700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
Objective To determine whether there are differences in the intensity of chronic pain of elderly caregivers who are frail, pre-frail and non-frail. Methods Quantitative, descriptive and cross-sectional study. The subjects were 187 elderly caregivers evaluated with a Multidimensional Pain Assessment Scale and the Fried Frailty Phenotype Assessment Components. Descriptive and comparative analyzes, Pearson's chi-square test and Kruskal-Wallis test were used. Results 24.1% of the caregivers were frail, 55.1% pre-frail and 20.9% non-frail. The only socio-demographic variable that differed between the three groups was age (p=0.03). Mean pain intensity values were as follows: frail elderly (6.98), pre-frail (6.38) and non-frail (5.85). However, these differences were not significant (p=0.150). Conclusions The present study did not find a significant difference in the intensity of chronic pain in elderly. Nevertheless, it is essential that health professionals and health care public policies give special attention to older caregivers.
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Affiliation(s)
- Daiene de Morais
- Universidade Federal de São Carlos (UFSCAR). São Carlos, São Paulo, Brasil
| | - Mariélli Terassi
- Universidade Federal de São Carlos (UFSCAR). São Carlos, São Paulo, Brasil
| | - Keika Inouye
- Universidade Federal de São Carlos (UFSCAR). São Carlos, São Paulo, Brasil
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Broglio K, Pergolizzi J, Kowalski M, Lynch SY, He E, Wen W. Long-term effectiveness and safety of once-daily, single-entity, extended-release hydrocodone in patients of ≥75 years of age with moderate to severe nonmalignant and nonneuropathic pain. Geriatr Nurs 2017; 38:39-47. [DOI: 10.1016/j.gerinurse.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 11/29/2022]
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Abstract
Given the current demographic changes there are an increasing number of elderly and very elderly patients in outpatient and inpatient care. Elderly and very elderly patients often suffer from pain and musculoskeletal conditions are a common cause of pain in the elderly. An effective pain management should not be withheld from elderly patients with rheumatic diseases. Untreated pain in elderly patients leads to functional impairment and immobility. In addition, the quality of life of patients is negatively affected and can lead to a loss of autonomy and/or social withdrawal. The treatment of elderly and very elderly patients is particularly challenging. There are special features that need to be considered in the choice of treatment. Altered pain presentation, comorbidities, nonadherence, polypharmacy and side effects of pain medications require a critical risk-benefit assessment and ongoing treatment monitoring of this special group of patients.
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37
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Saibertová S, Pokorná A. Evaluation of the assessment and documentation of chronic wounds in residential social care in the Czech Republic. J Wound Care 2016; 25:662-669. [PMID: 27827283 DOI: 10.12968/jowc.2016.25.11.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Accurate evaluation of non-healing, chronic wounds followed by the selection of an appropriate therapeutic strategy is a must for the foundation of health-care management. Assessment of non-healing chronic wounds in clinical practice in the Czech Republic is not standardised in acute care settings or in residential social care facilities. The aim of the study was to analyse the methods being used to assess non-healing, chronic wounds in residential social services in the Czech Republic, where more patients with chronic wounds are present because of the increasing incidence of wounds in old age. METHOD The research was carried out at 66 residential social care institutions across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The same methodology was used in previous work which has been done in acute care settings in 2013. RESULTS The results of this research have corroborated the inconsistencies in procedures used by general nurses for assessment of non-healing, chronic wounds. However, the situation was found to be more positive with regard to the evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of the wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were improved when a consultant for wound healing was present. CONCLUSION An effective strategy for wound management depends on the method and scope of the assessment of non-healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of 'non-healing, chronic wound assessment' algorithm.
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Affiliation(s)
- S Saibertová
- Associate Professor (docent) Masaryk University, Faculty of Medicine, Department of Nursing. Brno, Czech Republic
| | - A Pokorná
- Associate Professor (docent) Masaryk University, Faculty of Medicine, Department of Nursing. Brno, Czech Republic
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Lohman MC, Whiteman KL, Greenberg RL, Bruce ML. Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes. J Gerontol A Biol Sci Med Sci 2016; 72:216-222. [PMID: 28087677 DOI: 10.1093/gerona/glw212] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement. METHODS Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component. RESULTS In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain). CONCLUSIONS Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.
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Affiliation(s)
- Matthew C Lohman
- Department of Community and Family Medicine of the Dartmouth Geisel School of Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire. .,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen L Whiteman
- Department of Community and Family Medicine of the Dartmouth Geisel School of Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Rebecca L Greenberg
- Department of Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Martha L Bruce
- Department of Community and Family Medicine of the Dartmouth Geisel School of Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Stegemann S. Towards better understanding of patient centric drug product development in an increasingly older patient population. Int J Pharm 2016; 512:334-342. [DOI: 10.1016/j.ijpharm.2016.01.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
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Thé KB, Gazoni FM, Cherpak GL, Lorenzet IC, Santos LAD, Nardes EM, Santos FCD. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale. EINSTEIN-SAO PAULO 2016; 14:152-7. [PMID: 27462888 PMCID: PMC4943348 DOI: 10.1590/s1679-45082016ao3628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese in demented elderly and to analyze its measurement properties. Methods We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver’s opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. Results The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach’s alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. Conclusion The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese had adequate measuring properties for use with elderly presenting limited communication.
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Affiliation(s)
- Karol Bezerra Thé
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Relationships Among Adverse Events, Disease Characteristics, and Demographics in Treatment of Postherpetic Neuralgia With Gastroretentive Gabapentin. Clin J Pain 2016; 31:983-91. [PMID: 25811794 PMCID: PMC4894771 DOI: 10.1097/ajp.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives: To characterize risk factors for occurrence of adverse events (AEs) and treatment discontinuations due to AEs for improving safety and tolerability of treatment of postherpetic neuralgia (PHN). Methods: Patients with PHN (n=556) received 1800 mg once-daily gastroretentive gabapentin (G-GR) in 2 phase 3 and 1 phase 4 study. Safety assessments included the incidence and severity of AEs and analysis of discontinuations due to AEs. Multivariable, logistic regression analyses examined predictors of AE reporting and discontinuations due to AEs. Results: In total, 53.2% of patients reported any AE, and 12.9% discontinued because of AEs. Both AE incidence and treatment discontinuations decreased rapidly during the 2-week titration to sustained, low levels. The probability to report any AE was 0.6 for females versus 0.4 for males, whereas there were no differences in probabilities for age (less than 75 vs. 75 y and older) and race (nonwhite vs. white). Consistent with this, only female sex was a significant (P=0.0006) predictor of AE reporting. Experiencing moderate (P≤0.0001) or severe (P=0.0006) AEs, but not patient demographics, was predictive of treatment discontinuations. The probability of discontinuation due to moderate AEs was 0.4 and 0.5 for severe AEs. Discussion: The tolerability of G-GR was not affected by patient age, but was affected by AE severity. Although being female was predictive of reporting AEs, it did not influence treatment discontinuation. Given that PHN is a disease for which the risk and duration of PHN increases with age and with being female, G-GR appears to be a well-suited treatment option for PHN.
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Rapo-Pylkkö S, Haanpää M, Liira H. Chronic pain among community-dwelling elderly: a population-based clinical study. Scand J Prim Health Care 2016; 34:159-64. [PMID: 27065337 PMCID: PMC4977938 DOI: 10.3109/02813432.2016.1160628] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 02/02/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To present the occurrence, characteristics, etiology, interference, and medication of chronic pain among the elderly living independently at home. DESIGN/SETTING A total of 460 subjects in three cohorts aged 75, 80 and 85 years respectively received visits by communal home-care department nurses for a cross-sectional survey. Of them, 175 had chronic (duration ≥ 3 months) pain with an average intensity of ≥ 4/10 and/or ≥ moderate interference in daily life. MAIN OUTCOME MEASURES Clinical assessment was performed for consenting subjects to define the location, intensity, etiology, type, interference and medications of chronic pain. RESULTS According to home visits, elderly people with chronic pain rated their health and mobility worse and felt sadder, lonelier and more tired than those without chronic pain. A geriatrician made clinical assessments for 106 patients with chronic pain in 2009-2013. Of them, 66 had three, 35 had two and 5 had one pain condition. The worst pain was musculoskeletal in 88 (83%) of patients. Pain was pure nociceptive in 61 (58%), pure neuropathic in 9 (8%), combined nociceptive and neuropathic pain in 34 (32%), and idiopathic in 2 (2%) patients. On a numerical rating scale from 0 to 10, the mean and maximal intensity of the worst pain was 5.7 and 7.7, respectively, while the mean pain interference was 5.9. Mean pain intensity and maximal pain intensity decreased by age. Duration of pain was longer than 5 years in 51 (48%) patients. Regular pain medication was used by 82 (77%) patients, most commonly paracetamol or NSAIDs. Although pain limited the lives of the elderly with chronic pain, they were as satisfied with their lives as those without chronic pain. CONCLUSIONS Elderly people in our study often suffered from chronic pain, mostly musculoskeletal pain, and the origin of pain was neuropathic in up to 40% of these cases. However, elderly people with chronic pain rarely used the medications specifically for neuropathic pain. Based on increased loneliness, sadness and tiredness, as well as decreased subjective health and mobility, the quality of life was decreased among those with chronic pain compared with those without pain. KEY POINTS It is known that chronic pain is one of the most common reasons for general practice consultations and is more common in women than men. In our study using detailed clinical examinations, up to 40% of patients with chronic pain in cohorts aged 75, 80 and 85 years suffered from neuropathic pain. However, only a few elderly people with chronic pain used medications specifically for chronic pain, which may be due to side effects or non-willingness to experiment with these drugs. Elderly people with chronic pain rated their health and mobility to be worse and felt sadder, lonelier and more tired but were not less satisfied with their lives than those without chronic pain.
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Affiliation(s)
- Susanna Rapo-Pylkkö
- Kirkkonummi Health Center, Kirkkonummi, Finland;
- Department of General Practice, Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland;
| | - Maija Haanpää
- Mutual Insurance Company, Etera, Finland;
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland;
| | - Helena Liira
- Department of General Practice, Unit of Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland;
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
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Muntinga ME, Jansen APD, Schellevis FG, Nijpels G. Expanding access to pain care for frail, older people in primary care: a cross-sectional study. BMC Nurs 2016; 15:26. [PMID: 27110220 PMCID: PMC4842300 DOI: 10.1186/s12912-016-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/16/2016] [Indexed: 12/15/2022] Open
Abstract
Background Although untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. To explore this, we investigated whether new pain cases were identified by practice nurses during CGAs administered as part of an intervention with the Geriatric Care Model, a comprehensive care model based on the Chronic Care Model, and whether the intervention led to tailored pain action plans in care plans of frail, older people. Methods We used cross-sectional data from the older Adults: Care in Transition (ACT) study, a 2-year clinical trial carried out in two regions of the Netherlands. Practice nurses proactively visited older people at home and administered an in-home CGA that included an assessment of pain. Pain care-related agreements and actions (pain action plans) based on CGA results were described in a tailored care plan. We analyzed care plans of 781 older people who received a first-time CGA by a practice nurse for the presence of pain, pain location and cause, new pain cases, and pain action plans. We used descriptive statistics to analyze our data. Results We found that 315 (40.3 %) older people experienced any type of pain. Practice nurses identified 20 (10.6 %) new pain cases, and 188 (59.7 %) older people with pain formulated at least one therapeutic or non-therapeutic pain action plan together with a practice nurse. More than half of the older people whose pain had already been identified by a primary care physician wanted a pain action plan. Most pain action plans consisted of actions or agreements related to continuity of care. Discussion and conclusion Practice nurses in primary care can contribute to expanding older people's access to tailored pain care. Future researchers should continue to direct their focus at ways to overcome the barriers that restrict older people’s access to pain care.
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Affiliation(s)
- M E Muntinga
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schellevis
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands ; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Booker SS, Bartoszczyk DA, Herr KA. Managing pain in frail elders. AMERICAN NURSE TODAY 2016; 11:https://www.americannursetoday.com/managing-pain-frail-elders/. [PMID: 28018518 PMCID: PMC5179031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Staja Star Booker
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242
| | - Dorota A Bartoszczyk
- The University of Iowa Hospitals and Clinics, 50 Newton Road, Iowa City, IA 52242
| | - Keela A Herr
- The University of Iowa, College of Nursing, 50 Newton Road
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Østergaard PJ, Gustafsson LN, Høyer EH, Munk-Jørgensen P. The type and prevalence of the use of analgesics among inpatients in a geriatric psychiatry department. Ther Adv Psychopharmacol 2016; 6:13-21. [PMID: 26913174 PMCID: PMC4749741 DOI: 10.1177/2045125315619557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The association between the presence of pain and mental disorder is well known. The extent of pain treatment in psychiatric patients is estimated to be high, but there is a lack of recent studies focusing on analgesic treatment in patients with mental disorders. The use of analgesics can be associated with side effects, and it is possible that analgesics are not the correct treatment for chronic pain among patients with mental disorders. METHODS Data were obtained among inpatients in a geriatric psychiatry department at Aarhus University Hospital, Risskov, Denmark, between 1 April 2013 and 1 October 2013. The study examines the extent of analgesic use by patients at admission with a follow up at discharge to note any change during hospitalization. RESULTS A total of 89 patients aged 68 years or older were included (56 women, 33 men). At admission, 51.7% used analgesics, and this number did not change significantly from admission to discharge. A statistically significant increased risk of analgesic use was found in females (odds ratio 4.0). The indications for analgesic use were not present in 34.5% of the pain-treated patients at admission. At discharge, this number had been reduced to 23.1%. Paracetamol was the drug most frequently used, followed by opioids. CONCLUSIONS The use of analgesics among aged psychiatric inpatients is high. An increased focus on this topic is recommended.
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Kruschinski C, Wiese B, Dierks ML, Hummers-Pradier E, Schneider N, Junius-Walker U. A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain. BMC FAMILY PRACTICE 2016; 17:8. [PMID: 26821717 PMCID: PMC4730623 DOI: 10.1186/s12875-016-0409-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate what a geriatric assessment in general practice adds towards previous findings of prevalence, location, impact and the dyadic doctor-patient perception of pain in this age group. METHODS Cross-sectional study. Consecutive patients aged 70 and over underwent a comprehensive geriatric assessment in general practice that included a basic pain assessment (severity, sites and impact). Patients with pain and their doctors then independently rated its importance. Pain was correlated with further findings from the assessment, such as overall health, physical impairments, everyday function, falls, mood, health related lifestyle, social circumstances, using bivariate and multivariate statistics. Patient-doctor agreement on the importance of pain was calculated using kappa statistics. RESULTS 219 out of 297 patients (73.7 %) reported pain at any location. Pain was generally located at multiple sites. It was most often present at the knee (33.9%), the lumbar spine (33.5%) as well as the hip (13.8%) and correlated with specific impairments such as restrictions of daily living (knee) or sleep problems (spine). Patients with pain and their physicians poorly agreed on the importance of the pain problem. CONCLUSIONS A basic pain assessment can identify older patients with pain in general practice. It has resulted in a high prevalence exceeding that determined by encounters in consultations. It has been shown that a geriatric assessment provides an opportunity to address pain in a way that is adapted to older patients' needs - addressing all sites, its specific impact on life, and the patients' perceived importance of pain. Since there is little doctor-patient agreement, this seems a valuable strategy to optimize concrete treatment decisions and patient centered care. TRIAL REGISTRATION This study is registered in the German Clinical Trial Register ( DRKS00000792 ).
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Affiliation(s)
- Carsten Kruschinski
- Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Marie-Luise Dierks
- Institute of Epidemiology, Public Medicine and Healthcare Systems Research, Hannover Medical School, Hannover, Germany.
| | - Eva Hummers-Pradier
- Department of General Practice, University Medical Centre, Göttingen, Germany.
| | - Nils Schneider
- Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - Ulrike Junius-Walker
- Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
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Abstract
Persistent pain affects the elderly disproportionally, occurring in 50% of elderly community-dwelling patients and 80% of aged care residents. The management of pain in the elderly and frail patient is complicated because of the risks posed by changes in pharmacokinetics and pharmacodynamics, polypharmacy, and drug-disease interactions. Trials evaluating the efficacy of analgesics have often excluded elderly patients and universally excluded frail patients; therefore, the true efficacy and side-effect profiles in these population groups are largely unknown, especially for long-term use. A stepwise approach is recommended to managing pain, commencing with paracetamol and adding on opioids when needed to manage pain. However, because of the short duration of clinical trials, exclusion of frail patients, and minimal inclusion of elderly patients, the decision as to which opioid should be added on to paracetamol is a difficult one. This article reviews the evidence surrounding a newer opioid, tapentadol. Tapentadol acts on both the mu receptors and on neuronal reuptake of noradrenaline, and has no significant analgesically active metabolites, which theoretically presents some advantages, particularly in comparison with tramadol. However, the evidence to support tapentadol is weak and the trials were often methodologically poor and sponsored almost universally by the drug company. Currently, there is insufficient evidence to support the use of tapentadol over other opioids, which have been on the market longer, are less expensive, and have better established safety profiles. As a first-line agent after the failure of paracetamol alone, morphine, oxycodone, fentanyl, or buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for elderly or frail patients.
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Jamsen KM, Turner JP, Shakib S, Singhal N, Hogan-Doran J, Prowse R, Johns S, Bell JS. Analgesic Use and Pain in Robust, Pre-Frail and Frail Older Outpatients with Cancer. Drugs Real World Outcomes 2015; 2:117-121. [PMID: 27747766 PMCID: PMC4883190 DOI: 10.1007/s40801-015-0022-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Pain management can be challenging in frail older people with cancer due to drug–drug interactions and heightened susceptibility to adverse drug events. Objective To investigate the relationship between analgesic use and pain by frailty status in older outpatients with cancer. Methods A total of 385 consecutive patients aged 70 years and over who presented to an outpatient oncology clinic between January 2009 and July 2010 completed structured assessments of analgesic use (opioids, paracetamol or non-steroidal anti-inflammatory drugs), pain (10-point visual analogue scale) and clinical factors. Frailty was derived using modified Fried’s frailty phenotype. Logistic regression was used to compute adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for the relationship between analgesic use and pain for each frailty group (robust, pre-frail or frail). Results For robust outpatients (n = 101), there was weak evidence for a 30 % relative increase in the adjusted odds of analgesic use between outpatients who differed by one unit of pain score (95 % CI 0.995−1.71, p = 0.0532). For pre-frail outpatients (n = 190), there was evidence for a negative quadratic relationship (adjusted OR for the quadratic coefficient: 0.952, 95 % CI 0.910−0.993, p = 0.0244). For frail outpatients (n = 94), there was an 8 % relative increase in the adjusted odds of analgesic use between outpatients who differed by one unit of pain score, but no statistical evidence for association (95 % CI 0.934−1.26; p = 0.298). Conclusions These findings can be considered for the ongoing development of safe, effective strategies for analgesic use in older outpatients with cancer.
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Affiliation(s)
- Kris M Jamsen
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia. .,Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
| | - Justin P Turner
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nimit Singhal
- University of Adelaide and Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jonathon Hogan-Doran
- University of Adelaide and Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert Prowse
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sally Johns
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - J Simon Bell
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.,Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
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Hassani A, Kubicki A, Brost V, Mourey F, Yang F. Kinematic analysis of motor strategies in frail aged adults during the Timed Up and Go: how to spot the motor frailty? Clin Interv Aging 2015; 10:505-13. [PMID: 25759570 PMCID: PMC4345997 DOI: 10.2147/cia.s74755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective The purpose of this work was to analyze and compare the movement kinematics of sit-to-stand (STS) and back-to-sit (BTS) transfers between frail aged adults and young subjects, as well as to determine the relationship between kinematic changes and functional capacities. Methods We analyzed the Timed Up and Go (TUG) movements by using a 3D movement analysis system for real-time balance assessment in frail elderly. Ten frail aged adults (frail group [FG]) and ten young subjects (young group [YG]) performed the TUG. Seven spatiotemporal parameters were extracted and compared between the two groups. Moreover, these parameters were plotted with TUG test duration. Results The experiments revealed that there were significant differences between FG and YG in trunk angle during both STS and BTS, and in TUG duration. The trunk angle of the young subjects was more than two times higher than that of the FG. As expected, the TUG duration was higher in the FG than in YG. Trunk angles during both transfers were the most different parameters between the groups. However, the BTS trunk angle and STS ratio were more linked to functional capacities. Conclusion There was a relationship between kinematic changes, representing the motor planning strategies, and physical frailty in these aged adults. These changes should be taken into account in clinical practice.
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Affiliation(s)
- Asma Hassani
- Laboratoire LE2I CNRS 6306, Université de Bourgogne, Dijon, France
| | - Alexandre Kubicki
- Institut National de la Santé et de la Recherche Médicale (INSERM), Cognition Action et Plasticité Sensori-Motrice, Campus Universitaire, Université de Bourgogne, Dijon, France ; Centre Hospitalier Universitaire de Dijon, Hôpital de Champmaillot, Dijon, France
| | - Vincent Brost
- Laboratoire LE2I CNRS 6306, Université de Bourgogne, Dijon, France
| | - France Mourey
- Institut National de la Santé et de la Recherche Médicale (INSERM), Cognition Action et Plasticité Sensori-Motrice, Campus Universitaire, Université de Bourgogne, Dijon, France ; Faculté de Médecine, Université de Bourgogne, Dijon, France
| | - Fan Yang
- Laboratoire LE2I CNRS 6306, Université de Bourgogne, Dijon, France
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Eckerblad J, Theander K, Ekdahl A, Unosson M, Wirehn AB, Milberg A, Krevers B, Jaarsma T. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatr 2015; 15:1. [PMID: 25559550 PMCID: PMC4292813 DOI: 10.1186/1471-2318-15-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022] Open
Abstract
Background Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods A cross-sectional study including 378 community-dwelling people ≥ 75 years, who had been hospitalized ≥ 3 times during the previous year, had ≥ 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.
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Affiliation(s)
- Jeanette Eckerblad
- Department of Social and Welfare Studies, Linkoping University, Linkoping, Sweden.
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