The burden of geriatric pain increases proportionately with the growth of the number of Medicare beneficiaries (Manchikanti et al., 2012; Manchikanti, Helm, Singh, & Hirsch, 2013). Taking into consideration the mounting humanitarian and economic costs of pain, healthcare professionals should be keenly aware of effective pain management methods that can improve the well-being of elderly patients. The aim of this paper is to discuss approaches to pain management in the geriatric population.
An article by Rastogi and Meek (2013) outlines systematic pain management guidelines for the elderly population. Geriatric pain is prevalent among 50 to 75 percent of older adults and remains largely undiagnosed (Rastogi & Meek, 2013). The article enumerates the following barriers to pain management for the group of patients under discussion: misunderstandings, fear, noncompliant personalities, comorbidities, a lack of knowledge and standardization, and self-medication among others.
Pain assessment is the first step in addressing the issue of pain among older patients. A comprehensive pain evaluation process starts with the analysis of medical and medication histories. The initial stage is followed by a physical examination and pain measurement. According to Rastogi and Meek (2013), the choice of a pain assessment instrument should be based on cognitive and perceptual capacities of a patient. It is also essential to assess how an older adult is affected by pain before developing a management plan.
The symptom of aging is a multidimensional problem that is approached with the help of educational, nonpharmacological, and pharmacological modalities. Education is aimed at overcoming the key pain management barriers. Nonpharmacological pain management strategies include “physical therapy, psychobehavioral therapies, and pastoral and social work consultation” (Rastogi & Meek, 2013, p. 40). In addition, nutritional and lifestyle discussions should also be used to better control pain.
When it comes to pharmacological modalities of geriatric pain management, several medications can be used. The choice of pharmacological agents and their delivery routes rests on considerations of comorbidity, non-invasiveness, drug-drug interactions, and therapeutic goals among others. Pain medications are roughly divided into three groups: non-opioids, opioids, and adjuvants (Rastogi & Meek, 2013). The authors of the article recommend using “the WHO three-step ‘analgesic ladder’” for effective geriatric pain management (Rastogi & Meek, 2013, p. 41).
A Pain Assessment Scale
The use of validated pain assessment instruments is of paramount importance for the management of pain in the geriatric population (Tracy & Morrison, 2013). The effectiveness of Verbal Descriptor Scales (VDSs) in the context of geriatric pain management has been proven by multiple lines of investigation. For example, the results of a study by Kaasalainen, Akhtar-Danesh, Hadjistavropoulos, Zwakhalen, and Verreault (2013) show that the methods relying on verbal pain reports are equal in their effectiveness to the evaluation of displayed pain behaviors.
The instrument helps to assess the intensity of pain in seniors whose cognitive and speaking abilities allow them to self-report. The scale was developed in 2007 by a professor at the University of Iowa—Keela Herr (“Verbal Descriptor,” n.d.). The tool is used by asking a patient to point on the scale the approximate intensity of their pain.
The paper has discussed how to properly approach geriatric pain management. It has been argued that prior to developing a pain management plan, it is necessary to assess the level of a patient’s pain with a meaningful degree of validity. The paper has presented the pain evaluation scale that has been effectively used by healthcare professionals around the country.
Kaasalainen, S., Akhtar-Danesh, N., Hadjistavropoulos, T., Zwakhalen, S., & Verreault, R. (2013). A comparison between behavioural and verbal report paint assessment tools for use with residents in long term care. Pain Management Nursing, 14(4), 106-114.
Manchikanti, L., Falco, F. J. E., Singh, V., Pampati, V., Parr, A. T., Benyamin, R. M.,… Hirsch, J. A. (2012). Utilization of interventional techniques in managing chronic pain in the Medicare population: Analysis of growth patterns from 2000 to 2011. Pain Physician, 15, 969-982.
Manchikanti, L., Helm, S., Singh, V., & Hirsch, J. A. (2013). Accountable interventional pain management: A collaboration among practitioners, patients, payers, and government. Pain Physician, 16, 635-670.
Rastogi, R., & Meek, B. D. (2013). Management of chronic pain in elderly, frail patients: Finding a suitable, personalized method of control. Clinical Interventions in Aging, 8, 37-46.
Tracy, B., & Morrison, R. S. (2013). Pain management in older adults. Clinical Therapeutics, 35(11), 1659-1668.