Her physician prescribes amitriptyline 50 mg q day. He told her there were therapies that could be used to control her cancer but that none of them could cure her cancer. She is prescribed continued supplementation of calcium and vitamin D and is referred for outpatient evaluation of osteoporosis because of her high risk of further fragility fractures both graded as moderate recommendations in the guideline.
The Hippocratic Oath describes medicine as an art, yet modern medicine is increasingly reliant on sophisticated science for its diagnostic techniques and medical treatments.
Bowsher reported that amitriptyline in a dose of 25 mg daily halved the incidence of postherpetic neuralgia at 6 months when commenced within 48 hours of the onset of the rash and continued for 90 days .
Discuss an approach to help Mrs. The art of medicine is not the antithesis of the scientific approach. There are many clinical scenarios that do not lend themselves to being answered in RCTs. IV fentanyl is a faster acting drug and would produce less sedation after the dressing change was completed.
She has no prior history of hip pain and is ambulatory with the use of a cane. Liver function tests are often normal despite these changes in the elderly liver.
They recognized that cancer pain relief is possible. Drug half-life, the ratio of the volume of distribution to clearance, is notably increased for several benzodiazepines and tricyclic antidepressants related to decreased kidney and liver clearance. The highest level of evidence is that obtained from randomized controlled trials RCTs and systematic reviews.
The technique of polypharmacy to control a series of medication side effects is not always ideal. She requires QID dry-to-dry dressing changes that are very painful; Sensory pain: He has had 3 weeks of radiation therapy and now has pain located in his lips external and internaltongue, hard and soft pallet, and some on the inside of both cheeks.
As patients age, the incidence and prevalence of certain pain syndromes increase. Agents may be used alone, but often the effects are enhanced when used in combination with other pain analgesics and nondrug strategies moderate quality of evidence, strong recommendation.
Application There are several other pain management options to consider. For this reason, following the WHO recommendations for pain management is appropriate. Central Nervous System Many elderly patients may present with neurologic disease and dysfunction, including transient ischemic attacks, strokes, dementia, or movement disorders.
She calls the office 2 days later reporting nervousness, diarrhea, runny nose, and tearing eyes. He was gentle and kind as he told her she had poorly differentiated nonsmall cell lung cancer metastatic to the other lung, both kidneys, and possibly the cervical spine.
Primary pain control advocated in the WHO guidelines is antitumor therapy. Various factors make the management of persistent pain more difficult in this population. You are saddened by the change in her appearance and you agree in your heart with the cardiologist that aggressive treatment of her CHF is of little value, perhaps futile.
He sat down next to Gypsy and talked with her about her lung cancer. Three months after her thigh pain started, another bone scan finally revealed metastatic disease in the right femur and T12 to L4 vertebrae to which 10 radiation treatments were administered. Some patients who may be unable to drive to meet a physician may require house calls or the assistance of home health care for follow-up.
The rigorous selection criteria required to ensure internal validity of RCTs has the effect of reducing the generalizability of the results.
The use of multimodal therapy to maximize pain control and minimize side effects is appealing. What if she had been 20 years of age?
Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing from posterolateral to anterolateral approach. The American Geriatric Society and the World Health Organization WHO have put together counsel to arrive at some form of consensus as to the best approach in this patient population.
He plans to have rehabilitation therapy in the acute postoperative period. As the disease progresses, Mrs. Her 24 hour IM morphine dose has been 64 mg. Multimodal therapy may allow a more effective treatment of pain by approaching it through different mechanisms.
He is not able to tolerate intravenous patient-controlled analgesia due to side effects of itching, nausea, and mild agitation. The results demonstrated that somatosensory thresholds for nonnoxious stimuli increase with age, whereas pressure pain thresholds decrease and heat pain thresholds show no age-related changes, which confirm previous studies as well.
The ability to handle medications changes with age related to changes in body composition together with alterations in renal and liver function. The pain physician should be aware that these problems may affect accurate assessment of pain as well as the efficacy of treatment.
How might her bereavement be affected by his lack of pain control? What dose of hydromorphone would be equivalent?Download Presentation PowerPoint Slideshow about 'Pain Management in Elderly Persons Case Studies' - trygg An Image/Link below is provided (as is) to download presentation.
Assessment and Management of Pain in the Elderly: Self-directed learning package for nurses in long-term care.
Toronto, Canada: Registered Nurses’ Association of Ontario. The following case study illustrates principals of evidenced-based care of an older adult experiencing delirium. Mrs. Emily Jones is an year-old woman who is admitted to the hospital for.
She saw a “pain management team” two years Case Studies - Home Health 4 of 9 Case 1: Faculty Guide The primary goals of this case are to assure that participants • identify ways to manage unrelieved pain • understand that persons can be distracted from their pain -- that lack of stereotypical pain.
In this case, the patient is having thoracic procedures, so the incision is going to be mainly in the thorax/thoracic region, and therefore the pain management needs to cover that area.
And the transmissions then go up the spinal cord to the brain. Pain Management for the Geriatric Patient Geriatrics Grand Rounds American Geriatrics Society, Pharmacologic Management of Persistent Pain in Older Persons.
American Geriatrics Society, Pharmacologic Management of Persistent Pain in Older Persons. JAGS Patient controlled analgesia •Barriers.Download