Appendix
B
EXECUTIVE
SUMMARY OF KEY RECOMMENDATIONS
OF THE AMERICAN GERIATRIC SOCIETY (AGS)
Clinical
Practice Guideline: The Management of Persistent Pain in Older Persons
- The key
to effective treatment of persistent pain lies in comprehensive assessment.
All older persons should be screened for persistent pain on initial
evaluation, on admission to any health care service, and periodically
thereafter. Any persistent pain that has an impact on physical function,
psychological function, or quality of life should be considered a significant
problem.
- The verbally
administered zero to ten scale is a good first choice for assessment
of pain intensity; however, other scales such as word descriptor scales,
faces scales, or pain thermometers may be more appropriate for some
patients.
- For those
with moderate to severe cognitive impairment, assessment of behaviors
and family or caregiver's observations are essential.
- The use
of placebos in clinical practice is unethical and there is no place
for their use in the management of persistent pain.
- 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.
- An individualized
program of physical activity should be designed to improve flexibility,
strength, and endurance, and should be maintained indefinitely.
- Patient
and caregiver education is an essential component in the management
of persistent pain.
- Health
care facilities that care for older patients should routinely conduct
quality assurance and quality improvement activities to enhance pain
management.
SOURCE: AGS
Panel on Persistent Pain in Older Persons. The Management of Persistent
Pain in Older Persons. American Geriatrics Society. J Am Geriatr Soc 2002;
50;6:1-20
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