Pain medicine : the official journal of the American Academy of Pain Medicine
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This article has the following two primary objectives: 1) to provide a discussion of the self-management of pain for older adults in relation to therapist-assisted cognitive behavioral procedures; and 2) to review the main features of a recently developed manualized pain self-management program for older adults. ⋯ Self-management outcomes may be inconsistent across studies partly because there is very limited standardization and manualization of self-management approaches. A manualized self-management program is described as an example of an approach that could easily be standardized and facilitate future investigations. It would be important for subsequent research to focus on the identification of subgroups of older patients who are most likely to benefit from self-management, and to determine whether self-management improves outcomes of future professionally administered treatments.
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Chronic or persistent pain is a common problem in older adults and is often associated with significant physical disability and psychosocial problems. The potential benefits, risks, and costs of pharmacotherapy as a mainstay in the treatment of moderate to severe pain in this population must be well-understood and weighed accordingly. Recent treatment guidelines have been introduced that can guide decision making to optimize pain-related treatment outcomes in older individuals ⋯ It is postulated that ongoing education of clinicians who treat older patients with persistent moderate to severe pain will lead to improved outcomes in this vulnerable population.
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Review
Age-related changes in the structure and function of brain regions involved in pain processing.
This review summarizes the scientific literature addressing the effects of aging on pain processing in the brain. ⋯ The network of brain regions involved in pain processing are subject to age-related changes in structure, but that the functional implications of these changes are yet to be determined.
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Evidence-based medicine has been adopted as a means of achieving optimal medical care and to reduce variations in clinical practice. Randomised controlled trials are considered the highest level of scientific evidence. Older individuals are either excluded or underrepresented in these studies, and those who are included are often atypical of patients seen in clinical practice. ⋯ The art of medicine is not the antithesis of the scientific approach. The art of medicine involves balancing the scientific evidence with the circumstances and the preferences of the patient. Combining the practices of Pain Medicine and Comprehensive Geriatric Assessment may result in a better outcome. When treating older people, clinicians not only need to take into consideration the severity of pain, but also the impact of pain and its treatment on cognition, mood and functional status.
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A dramatic increase in unintentional deaths from opioids has occurred over the past decade with strong inference that many of these deaths may be resulting from prescriber's error. Recent evidence suggests that the use of dose conversion ratios published in equianalgesic tables may lead to fatal or near-fatal opioid overdoses. The objective of this review was to determine whether the current practice of opioid rotation may be contributing to high rate of unintentional deaths. ⋯ Most of the fatal outcomes occurring during opioid rotation are preventable. The current process being used for opioid rotation has important flaws that must be corrected.