Reasons For Poor Pain Control In Seniors

Despite such high prevalence of pain and painful syndromes in older adults, there have been relatively few studies in older populations with pain (29). Studies have indicated that less than 1 of the thousands of papers published on pain focus on the aging society (30). This lack of research may explain part of the failure to provide adequate pain relief to seniors. A variety of other factors also seems to contribute to the dismal performance of the health care profession in providing...

Compliance Issues

Lack of compliance can be another impediment to attaining pain relief. Failure to take medication or to take it differently than prescribed can create havoc when trying to establish the best treatment regimen. Not only is it confusing to those trying to render therapy, but also there is an associated increase in risk for adverse events. For example, a patient who is taking more medication than prescribed may run out of medication before the prescription plan will fill a new prescription of a...

Social History And Habits

Social history and habits can also play an important role in pain management therapy. Smoking and alcohol use can complicate acute pain management. Patients who use alcohol on a regular basis can experience various degrees of withdrawal symptoms if it is discontinued abruptly. This is especially important in postsurgical patients. Alcohol withdrawal symptoms can occur 24 to 48 hours after abrupt discontinuation. Alcohol withdrawal can cause anxiety and agitation, which can make the patient far...

Peter J S Koo PharmD

Believe nothing that you see in the newspapers they have done more to create dissatisfaction than all other agencies. If you see anything in them that you know is true, begin to doubt it at once. As noted in Chapter 2, successful pain management must initially include careful review of the patient's experience with pain management and medications. This is especially important for patients suffering chronic pain. Such patients often feel that no one believes them, and they are fearful of being...

Selecting Pain Scales For Seniors

Few scales have been developed specifically with older individuals in mind. Almost none have been evaluated for responsiveness or sensitivity to changes in pain. Given the importance that hospitals and nursing homes are now mandated to place on pain assessment (and subsequent treatment and evaluation of that treatment), it is disturbing that most instruments to assess pain have not had such testing. Many scales are variations of an identical concept that is, the scale has one end that indicates...

Electrical Stimulation Of The Spinal Cord And Peripheral Nerves

Centuries before the nature of electricity was understood, observant people discovered that electrical stimulation (caused by the proximity of electrical eels) relieved pain. When electricity was controlled, healers replaced the eels with hand-cranked generators and continued to practice electrical therapy without understanding how it relieved pain (12). Eventually, in the mid-20th century, Melzack and Wall crafted a gate-control theory of pain that permitted the incorporation of electrical...

Nerve Destruction

Neurodestruction has a prolonged effect and is generally reserved to treat cancer pain. Several techniques are used to destroy nerves. Cryoablation can be accomplished by touching a nerve with a -60 C cryoprobe. This degenerates the nerve axons without damaging surrounding tissue. Nerves can also be destroyed by applying heat, phenol, or alcohol, or they can be cut with a surgical implement. With few excep- Fig. 4. (A) Anterior posterior view of lumbar sympathetic block. (B) Lumbar sympathetic...

References

Barry KL, Fleming MF, Greenley J, Widlak P, Kropp S, McKee D. Assessment of alcohol and other drug disorders in the seriously mentally ill. Schizophr Bull 1995 21 313-321. 2. Hancock D, Kennington JM, Beckner RR, Quick G. Emergency department medication and drug interaction evaluation. Hosp Pharm 1992 27 129-132. 3. Klungel OH, de Boer A, Paes AH, Herings RM, Seidell JC, Bakker A. Influence of question structure on the recall of self-reported drug use. J Clin Epidemiol 2000 53 273-277. 4. Lu...

Botulinum Toxins

Botulinum toxins block or reduce muscle contractions and spasms by interfering with the release of acetylcholine, which transmits the contraction signal from the brain to muscle. Botulinum toxins may also block parasympathetic nervous system action. Intermuscular injections of botulinum toxin performed on an outpatient basis three or four times per year are used to treat many conditions that involve abnormal muscle contraction. Hsiung et al. reported that, during a 10-year period, they found...

Intradiscal Electrothermal Annuloplasty And Nucleoplasty

Radiofrequenz Nucleoplasty

The interior nucleus pulposus of a disc can bulge out of its tough outer annulus fibrosis, creating what is commonly known as a herniation and Fig. 10. Anterior posterior view of intradiscal electrothermal annuloplasty treated disk. Fig. 10. Anterior posterior view of intradiscal electrothermal annuloplasty treated disk. more properly called a disc protrusion. When this protrusion compresses a nerve root, it can cause serious problems. Two new minimally invasive techniques, intradiscal...