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Assessment and management of chronic pain in the older adult
James w. Cooper and Allison H. Burfield
James W. cooper, BPharm, Phd, BcPS, cGP, FaScP, FaShP, is Emeritus Professor and Consultant Pharmacist, College of Pharmacy, University of Georgia, Athens, and Clinical Assistant Professor of Family Medicine, Medical College of Georgia, Augusta. allison h. Burfield, rN, Phd, isAssistant Professor, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte. correspondence: James W. Cooper, BPharm, PhD, BCPS, CGP, FASCP, FASHP, 1200 Colliers Creek Rd., Watkinsville, GA 30677. E-mail: jcooper@mail.rx.uga.edu Published concurrently in Pharmacy Today and the Journal of the American Pharmacists Association (available online at www. japha.org).Abstract
Objective: To review the assessment and recommended management of mild to moderate chronic pain in the older adult. Data sources: Medline search using the terms pain, older adult, and analgesics, current national guidelines, and authors’ case experiences. Data synthesis: Assessing pain in cognitively intact and impaired older adults is essential to safe use of psychoactivemedications. Following the guidelines of the American Geriatrics Society for persistent pain in the older adult provides guidance to the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, inorder to avoid gastrointestinal, renal, and cardiovascular complications. Potentially inappropriate opioid analgesics and safer alternatives are encouraged. A description of other psychoactive medications for neuropathic pain and the role of vitamin D and depression in chronic pain is provided. Conclusion: The assessment of pain and use of analgesics in the older adult should benefit and not increasedrug-related morbidity and mortality. Keywords: Pain management, pain (chronic), elderly, opioid analgesics, medication management, adverse drug effects. Pharmacy Today. 2010(May);50(5):31–43.

Accreditation Information

At the completion of this activity, the pharmacist will be able to: ■ Review the most common causes and comorbidities of chronic pain in the older adult. ■ Discuss assessmenttechniques for pain assessment in the cognitively intact and impaired older adult. ■ Differentiate the safest and most effective pharmacologic treatments for chronic pain in the older adult. ■ Delineate inappropriate pain medications and detail alternatives to these medications to minimize the risk of adverse drug reactions to these medications. ■ Estimate the risk of long-term full-dose NSAIDsand the significance of adverse drug reactions that occur with these agents.

Learning objectives

Provider: American Pharmacists Association Target audience: Pharmacists Release date: May 1, 2010 Expiration date: May 1, 2013 ACPE number: 202-000-10-127-H01-P CPE credit hours: 2.0 hours (0.2 CEUs) ACPE activity type: Knowledge-based Fee: There is no fee associated with this activity for membersof the American Pharmacists Association. There is a $15 fee for nonmembers The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of CPE. The ACPE Universal Activity Number assigned to the program by the accredited provider is 202-000-10-127-H01-P. Disclosure: Other than continuing education programs developed by the authors or APhAand mentioned as resources for more information, the authors and APhA’s editorial staff declare no conflicts of interest or financial interests in any products or services mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.


may 2010 • Pharmacy Today 31

reviews chronic pain in older adults

Acute versus chronic pain: Overview...