Pain Screening
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TREATMENT
WHO's Pain Ladder
The World Health Organization (WHO) has developed a three-step "ladder" for cancer pain relief that healthcare providers often use to guide treatment of other types of chronic pain (2). Here's a summary from WHO's website:
"If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol [or acetaminophen]); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs …should be used. To maintain freedom from pain, drugs should be given 'by the clock', that is every 3-6 hours, rather than 'on demand.' This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective."
Keep in mind that where you start on this ladder depends on the resident's pain intensity. The greater the pain, the higher up the ladder you should start.
From: www.who.int/cancer/palliative/painladder/en/
AGS Panel on Persistent Pain in Older Persons
Among its recommendations, the American Geriatrics Society's (AGS) Panel on Persistent Pain in Older Persons offers these guidelines for the treatment of pain (3):
- "Acetaminophen should be the first drug to consider in the treatment of mild to moderate pain of muskuloskeletal origin.
- "Traditional (i.e., nonselective) nonsteroidal anti-inflammatory drugs (NSAIDS) should be avoided in those who require long-term daily analgesic therapy. The selective NSAIDs, i.e., the COX-2 inhibitors, are preferable.
- "Opioid analgesic drugs are effective, associated with a low potential for addiction, and overall may have fewer long-term risks than other analgesic drug regimens in older persons with persistent pain. As with all medication, careful monitoring for the development of adverse side effects is important."
Exercise Effects on Pain in Nursing Home Residents
Clinical practice guidelines for the treatment of pain recommend exercise as an important adjunct to treatment and essential to rehabilitation for arthritis and other chronic, non-cancer pain problems (3-5). These guidelines are based largely on evidence that exercise reduces pain symptoms in young and old populations with arthritis (6-8). In a recent study, however, we found that exercise does not alleviate pain among nursing home residents, and indeed, may tend to increase pain in this frail population (9). Click here to read a summary of this study.
Our findings suggest that exercise alone may be ineffective for pain management among nursing home residents. Care providers should consider that exercise to improve physical function may increase pain complaints, thereby requiring pre-emptive analgesia, other pain control strategies, or modified exercise techniques.
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