Evaluation of elderly patients with chronic pain should include identification of risk factors, a comprehensive pain history, a physical exam focused on cognitive, motor, and sensory assessments, and relevant diagnostic tests, the authors suggest.
When selecting analgesic therapy, clinicians must be mindful of age-related physiologic changes, such as reduced intravascular volume, muscle mass, and renal function, Dr Manworren pointed out.
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is not recommended because of the increased risk for adverse gastrointestinal, cardiovascular, and renal effects. Dose reductions may be required for other agents.
Cognitive behavior therapy, self-management programs, rehabilitation, and exercise programs should all be part of a multimodal approach to pain management, the authors emphasize.
Opioid Abuse Linked to Pain Relief, Not Addiction
The most prevalent motivation for medical misuse of opioids (84.2%) is to relieve pain, the authors write, suggesting that the prevalence of addiction-related drug-seeking behavior is often overestimated.
“The most intriguing suggestion from this portion of the article was that clinicians may be overestimating the number of patients seeking opioid pain relievers secondary to abuse/addiction versus those patients presenting with true chronic pain needs,” Robert “Chuck” Rich, Jr, MD, told Clinical Pain Advisor.
“This point runs counter to the popular perception and initiatives being devoted to the ‘opioid crisis’ — [the idea] that many of the patients being seen in our offices for opioids are there because of opioid abuse and addiction,” Dr Rich pointed out.
Dr Rich is medical director of Community Care of the Lower Cape Fear in Wilmington, North Carolina, and 2015 chairperson of the American Academy of Family Physicians’ Commission on Health of the Public and Science. He was not involved in the review.