Geriatrics
-
Review
Herpetic neuralgia. Use of combination therapy for pain relief in acute and chronic herpes zoster.
Herpes zoster (shingles) is a localized infection that begins in the dorsal root ganglla of the cranial or spinal nerves and spreads as a rash over the corresponding dermatome. It usually is caused by reactivation of latent varicella-zoster virus remaining from childhood chicken pox. ⋯ Management of zoster-related pain should begin as soon as possible after the onset of symptoms. Combination therapy--including antiviral, antidepressant, corticosteroid, opioid, and topical agents--provides the most effective analgesia.
-
For many older patients, surgery is an inevitable component of healthcare. Thorough and effective preoperative patient evaluation is imperative because comorbidities, polypharmacy, functional problems, and socio-economic issues all can affect perioperative decisions and complicate recovery. ⋯ Other major considerations include functional status, the risk level of the surgery to be performed, expected blood loss, and anesthesia duration. The primary care physician must synthesize and relay this patient data to the surgical team so that appropriate measures can be taken to minimize perioperative risks and promote uncomplicated recovery.
-
Review
Prescribing analgesics. How to improve function and avoid toxicity when treating chronic pain.
Analgesic drugs are used more often than nondrug therapies for the treatment of pain in older patients. Despite the risk of adverse reactions, analgesics can be used safely for chronic pain in older patients when physicians prescribe with care. Nonopoid analgesics include acetaminophen, aspirin, NSAIDs, and COX-2 inhibitors. ⋯ Adjuvant medications include antidepressants, anticonvulsants, neuroleptics, and oral membrane stabilizers. Benzodiazepines may be harmful in older patients, and muscle relaxants tend to be overused. Topical agents may be useful for certain neuropathic pain conditions.