Pain Management in the Elderly: 7 Things to Consider (Part 2)

(Continued from part 1 of “Pain Management in the Elderly: 7 Things to Consider”)

Pain management doesn't necessarily mean a patient will no longer experience the pain after being treated, because for some people and certain types of pain, that is not reasonable. Reducing the pain to a tolerable level that allows us to function as well as possible may be considered excellent pain management.

There are physical indicators of pain in persons who cannot communicate pain and ways to recognize pain are facial grimacing or moaning and yelling out, particularly with movement.

Guarding the painful area, such as not using an arm that is hurting or limping are examples of nonverbal pain indicators. Decreased mobility, decreased appetite, mood changes and changes in blood pressure and/or pulse can all indicate pain.

What is more difficult is to understand the type and intensity of the pain. Doctors and nurses want to know types of pain, such as burning, aching or throbbing. Persons unable to communicate the type have to be thoroughly assessed to find the cause.

Grimacing, or moaning and yelling out can be an indication of intensity but may not be in persons with dementia. Those actions could relate to other thoughts or activities a person finds displeasing.

Untreated pain in the elderly can result in depression, decreased activity or decreased food and fluid intake. It can cause pain in other areas from guarding arms, legs or back, putting pressure on other areas of the body.

Untreated pain in persons with dementia can be expressed in behavioral problems that are inaccurately treated or sleep problems. Untreated pain causes a variety of additional problems, and that is one reason it's so important to recognize, assess, and accurately treat pain.

We don't want to see an Alzheimer's patient put on antipsychotic, anti-anxiety or sleeping pills because they have uncontrolled pain. Many elderly individuals have been misdiagnosed and treated improperly because of undiagnosed and untreated pain.

Here are seven important considerations to remember:

1. We all have to keep in mind that pain in any form is not normal.
    
2. We all experience pain differently.
    
3. We do not and should not just endure pain without treatment.
    
4. Person with dementia, and others unable to communicate, will and do experience pain. Monitoring for pain on a daily basis is extremely important and should be one of the first considerations if there are notable changes in functioning and demeanor.
    
5. We must advocate for ourselves and family members for pain assessments and adequate pain control. If your health care provider doesn't take pain your seriously, seek another provider who will.
    
6. Always monitor and report the effectiveness of a natural or prescribed treatment. If it is ineffective advocate for an alternative treatment that is effective.
    
7. Some pain medications can cause elderly patients to fall, or have hallucinations, so if there are any adverse side effects notify the physician immediately so an alternative medication can be ordered.