| Guidelines for Treating Persistent Pain |
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By Jennifer Sergent
Scripps Howard News Service Here is a summary of updated pain-management guidelines from the American Geriatrics Society. The first official guidelines were issued in 1998. Comprehensive Assessment. All older persons should be screened for persistent pain on initial evaluation. Any persistent pain that has an impact on physical function, psychological function or quality of life should be considered a significant problem. Method of assessment. The common "zero to 10" scale is a good first choice in getting patients to describe their pain intensity. Other methods include pain thermometers, "faces scales" or "word descriptor scales." It's essential to ask the opinion of family caregivers when a patient has a significant cognitive impairment. The use of placebos in clinical practice is unethical and there is no place for their use in the management of persistent pain. Acetaminophen (Tylenol) should be the first drug to consider to treat mild to moderate musculoskeletal pain. Traditional nonsteroidal anti-inflammatory drugs (Aleve, aspirin, ibuprofen) should be avoided in those who require long-term daily analgesic therapy. The selective NSAIDS, i.e., the COX-2 inhibitors (Celebrex, Vioxx) are preferable. Opioid analgesic drugs (OxyContin, morphine, codeine, Percocet) are effective, associated with a low potential for addiction. As with all medication, careful monitoring for development of adverse side effects is important. An individualized program of physical therapy should be designed to improve flexibility, strength and endurance, and should be maintained indefinitely. Patient and caregiver education is essential in the management of persistent pain. Health-care facilities that care for older patients should routinely conduct quality assurance and quality improvement activities to enhance pain management. (Contact Jennifer Sergent at SergentJ@shns.com or online at www.shns.com.)
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