Clinical Management of the Elderly Patient in Pain  book cover
1st Edition

Clinical Management of the Elderly Patient in Pain

ISBN 9780789026200
Published May 11, 2006 by CRC Press
326 Pages

FREE Standard Shipping
USD $32.95

Prices & shipping based on shipping country


Book Description

Up-to-date information on pain management—including options to consider when conventional treatment is ineffective

Providing effective treatment for pain-especially to elderly clients-can be a vexing problem for even the most knowledgeable clinician. In Clinical Management of the Elderly Patient in Pain, some of the world's leading authorities describe the unique difficulties that arise when trying to provide pain relief to elderly patients. They examine conventional treatment with opioid and non-steroidal anti-inflammatory drugs along with a broad range of alternatives to consider when frontline drugs fail. Non-drug options for pain relief from the fields of physical medicine and psychology are also explored.

Essential topics addressed in Clinical Management of the Elderly Patient in Pain include:

  • pain as an aspect of advancing age
  • how pharmacology differs in elderly patients
  • available therapeutic options, including opioids, non-steroidal anti-inflammatory drugs, anti-epileptic drugs, tricyclic antidepressants, membrane stabilizers, and topical agents
  • physical medicine approaches
  • psychological approaches to pain in the elderly
Most publications on this subject focus on the use of opioids, non-steroidal drugs, and other commonly prescribed analgesics. Clinical Management of the Elderly Patient in Pain takes a different approach. Editor Gary McCleane, MD, says, “Our need, with elderly patients, is to provide treatment that is both effective and easily tolerated. This is not a book devoted to opioids and non-steroidals, although they are addressed. Nor is it about those analgesics used in younger patients being used in smaller doses with the elderly. Rather, it contains practical options for treating pain when other simple remedies fail to help. At times this will involve using conventional analgesics in scaled-down doses, but at others it will involve using substances not yet fully recognized as possessing analgesic properties because they fit the bill in terms of possible analgesic actions, side-effect profiles, and lack of drug/drug interactions—and because practical experience suggests they may be useful in the scenario described.”

Clinical Management of the Elderly Patient in Pain is designed as a point of interface between the specialist pain practitioner and the clinician faced with all the problems of satisfactorily managing pain in elderly patients. It presents commonsense, practical, patient-oriented options that make it a useful resource for busy clinicians.

Table of Contents

  • About the Editors
  • Contributors
  • Preface
  • Chapter 1. Pain and the Elderly Patient (Gary McCleane)
  • An Aging Population
  • Neural Differences in the Aged
  • Effect of Age in Animal Pain Models
  • Effect of Age on Human Experimental Pain
  • Effect of Age on Clinical Pain
  • Conclusion
  • Chapter 2. Acute and Chronic Pain in the Elderly (Pradeep Chopra and Howard Smith)
  • Acute Pain
  • Chronic Pain
  • Cancer Pain
  • Chapter 3. Pain Management and Pharmacological Differences in the Elderly Patient (Peter Passmore and David Craig)
  • External Factors
  • Pharmacokinetic Alterations
  • Pharmacodynamic Changes
  • Conclusion
  • Chapter 4. Acetaminophen for the Elderly (Pradeep Chopra and Howard Smith)
  • Clinical Pharmacology
  • Adverse Effects
  • Laboratory Values Affected
  • Overdosage
  • Dosage and Administration
  • Chapter 5. Opioids (Gary McCleane)
  • Does Age Influence the Dose of Opioid Required to Achieve Analgesia?
  • Pain and Its Responsiveness to Opioids
  • Types of Opioid
  • Side Effects of Opioid Analgesics
  • Clinical Use of Opioids in the Elderly
  • Conclusion
  • Chapter 6. NSAIDs and the Elderly (Jennifer A. Elliott)
  • Mechanism of Action and Physiologic Effects of NSAIDs
  • Classification of NSAIDs and Individual Agents of Particular Concern in the Elderly
  • Potential Adverse Drug Interactions with NSAIDs in the Elderly
  • Conclusion
  • Chapter 7. Tramadol for the Elderly (Pradeep Chopra and Howard Smith)
  • Clinical Pharmacology
  • Adverse Events
  • Dosage and Administration
  • Guidelines for Using Tramadol in the Elderly
  • Chapter 8. Topical Local Anesthetics (Charles Argoff)
  • The Use of Topical Local Analgesics for Neuropathic Pain
  • The Use of Targeted Peripheral Analgesics for Pain Associated with Soft Tissue Injury and Osteoarthritis
  • The Use of Targeted Peripheral Analgesics for the Treatment of Low Back Pain and Myofascial Pain
  • Other Uses of Topical Analgesics
  • Summary
  • Chapter 9. Nitrates, Capsaicin, and Tricyclic Antidepressants (Gary McCleane)
  • Nitrates
  • Capsaicin
  • Tricyclic Antidepressants
  • Conclusion
  • Chapter 10. Topical Opioids (Gary McCleane)
  • Peripheral Opioid Receptors
  • Effect of Peripheral Application of Opioids for Acute Pain
  • Transdermal Fentanyl
  • Topical Morphine
  • Transdermal Buprenorphine
  • Other Modes of Administration of Strong Opioids
  • Conclusion
  • Chapter 11. Tricyclic Antidepressants As Analgesics in the Elderly (Mary E. Lynch and Jana Sawynok)
  • Systemic Tricyclic Antidepressants As Analgesics
  • Other Antidepressants As Analgesics
  • Comorbid Pain and Depression
  • Mechanisms of Action of Antidepressants As Analgesics
  • Topical Antidepressants As Analgesics in Clinical Studies
  • Chapter 12. Antiepileptics (Gary McCleane)
  • Neuropathic Pain
  • Selecting an AED
  • Specific AEDs
  • Side Effects of AEDs
  • Examples of Conditions That May Respond to Use of an AED
  • Conclusion
  • Chapter 13. Spinal Analgesia in the Elderly (Thomas M. Larkin and Steven P. Cohen)
  • Definitions
  • Physiologic Considerations
  • Anatomical Considerations
  • Neuraxial Analgesics in Perioperative and Chronic Pain Conditions
  • Local Anesthetics
  • Opioids
  • Alpha-2 Adrenergic Agonists
  • N-Methyl-D-Aspartate Receptor Antagonists
  • Calcium Channel Blockers
  • Adenosine
  • Cholinergic Agonists
  • Gamma-Aminobutyric Acid Agonists
  • Somatostatin
  • Neuroleptics
  • Aspirin and NSAIDs
  • Conclusion
  • Chapter 14. Oral and Intravenous Local Anaesthetics (Gary McCleane)
  • Oral Local Anaesthetics
  • Intravenous Local Anaesthetics
  • Conditions Benefiting from Intravenous Lidocaine
  • Suggested Clinical Use
  • Conclusion
  • Chapter 15. Muscle Relaxants (Howard Smith)
  • Pharmacologic Considerations for the Use of Muscle Relaxants in the Elderly
  • Muscle Relaxant Agents
  • Other Agents and Treatments
  • Summary
  • Chapter 16. Physical Therapy and Pain Management with the Elderly (Dennis Martin)
  • Function
  • Context
  • Consequences of Pain in the Elderly
  • Models of Pain Management
  • Role of the Physical Therapist
  • Physical Therapy Treatments
  • Goal Setting
  • Conclusion
  • Chapter 17. Psychosocial Factors in Pain Management of the Older Patient (Edmund J. Burke)
  • Age Differences in Prevalence Rates of Chronic Pain
  • The Nature of Pain States
  • Physical Differences in Pain Perception
  • Sociocultural Factors in the Experience and Report of Pain in Older Patients
  • Emotional and Psychological Factors Influencing Pain Experience
  • Practical Issues in the Assessment and Treatment of the Elderly Pain Patient
  • Summary
  • Chapter 18. Use of Psychotropic Medications in Geriatric Pain Management (Guerman Ermolenko)
  • Antidepressants
  • Antipsychotics
  • Significant Side Effects and Interactions of the Antidepressants
  • Strategies for Combined Psychiatric and Pain Syndromes
  • Conclusion
  • Chapter 19. Treatment of Common Conditions (Gary McCleane)
  • Central Post Stroke Pain
  • Cervical Radiculopathy
  • Fibromyalgia
  • Fracture Pain
  • Metastatic Bone Pain
  • Muscle Spasm
  • Osteoarthritis—Monoarticular
  • Osteoarthritis—Polyarticular
  • Painful Diabetic Neuropathy
  • Peripheral Vascular Disease
  • Postherpetic Neuralgia
  • Sciatica
  • Skin Ulcers
  • Tendonitis
  • Trigeminal Neuralgia
  • Visceral Pain
  • Appendix. Drug Interactions
  • Glossary
  • Index
  • Reference Notes Included

View More