Therapy of Chronic Pain
Chronic pain is very frequent in the elderly, and the prevalence rate increases with advancing age. The main reason for this rise is an increasing incidence of musculoskeletal disorders, such as osteoarthritis and osteoporosis. Up to 70% of persons aged 7
- PDF / 252,302 Bytes
- 18 Pages / 504.567 x 720 pts Page_size
- 39 Downloads / 209 Views
Relevance for Elderly Patients, Epidemiology Chronic pain is very frequent in the elderly, and the prevalence rate increases with advancing age. The main reason for this rise is an increasing incidence of musculoskeletal disorders, such as osteoarthritis and osteoporosis. Up to 70% of persons aged 70+ years complain about chronic pain (Brattberg et al. 1996). However, exact data depend on the assessment method, and prevalence rates in institutional care and specialized hospital departments may even exceed this value. If pain is recorded, one should distinguish between acute and chronic pain. Both variants are frequently found in the elderly (Ferrell et al. 1990). Chronic pain is of special interest in the context of pharmacotherapy as this condition almost always requires long-term drug treatment. Therefore, this chapter mainly refers to chronic pain. To define chronic pain and distinguish it from acute pain is somewhat arbitrary, and exact and consented criteria are lacking. A common definition describes chronic pain as pain lasting for at least 3 months (Charette and Ferrell 2007). However, this time frame may seem excessive and is thus a matter of dispute.
H. Burkhardt (*) IVth Department of Medicine, Geriatrics, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany e-mail: [email protected]
Pain, whether acute or chronic, severely influences quality of life and self-management competence. If pain remains poorly controlled, it may lead to disability. Disability may be inflicted by the limitation of locomotion and mobility, reduced muscle strength, and malnutrition due to loss of appetite. Furthermore, pain may result in behavioral changes, mood disturbances, cognitive decline, and anxiety. An optimized control of pain is a highpriority therapeutic goal for every form of pain and in each patient. In elderly patients, however, an early and proper detection of pain might be difficult. This is of great importance as untreated pain may lead to the crippling chronic pain syndrome involving cerebral and spinal remodeling. These late pain syndromes are very difficult to treat. An early detection and proper management of pain is demanding to avoid chronic pain syndromes. Unfortunately, there are abundant data underpinning the fact that undertreatment of pain syndromes in the elderly is very common. In an analysis after surgery including elderly patients aged 65+ years, up to 62% of these patients reported severe postsurgery pain and gaps in the postoperative pain monitoring (Sauaia et al. 2005). Another cross-sectional study not only disclosed a high prevalence rate of pain among elderly in nursing homes (49%) but also showed that 25% of residents did not receive any pain medication (Won et al. 2004).
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_14, # Springer-Verlag Wien 2013
161
162
In the elderly, pain is often undetected and undertreated. Undertreatment of pain is clearly inacceptable and a serious marker of inadequate treatment quality. I
Data Loading...
