Acute Pain: Considerations in Geriatric Patients

JULY 26, 2016
Laura Rhodes, PharmD, and Ashley Branham, PharmD, BCACP
Acute pain is the body’s normal response to noxious stimuli. Acute pain typically lasts for days to weeks, but it may last for months during the healing process.1,2 Because pain is a highly subjective experience, it is important for a thorough assessment to be conducted to determine the cause of pain and the most appropriate course of treatment. A pain management plan should consider the assessment of pain and all pertinent patient factors, as well as drug and nondrug measures that can be employed to relieve a patient’s pain. When a medication is selected to treat pain in a geriatric patient, factors that should be considered include drug metabolism mechanism, renal or kidney function, concomitant medical conditions, and social history, including the potential for drug abuse or history of addiction. If an assessment takes place in a community pharmacy setting, it is important to consider when a patient may require referral to a health care provider for a more in-depth acute pain evaluation.3,4
Assessment of Pain
The assessment of pain requires a multidimensional approach by clinicians because pain can present in many different ways and can affect patients physically and psychologically. A patient’s report of pain, in his or her own words, is the most reliable indicator of pain. A thorough pain assessment should inquire about the characteristics of the pain, past and current management strategies, medical history, family history, psychosocial concerns, and the patient’s goals and expectations for pain management. Characteristics of pain may include location and distribution, duration and periodicity, quality, and associated signs or symptoms.
Pain may be assessed using a unidimensional or multidimensional tool. Unidimensional scales are useful for a quick measurement of the intensity of an individual’s pain. The most common unidimensional pain assessment tools are the numeric rating scale, the visual rating scale, or a categorical rating scale. The Table5-7 provides illustrations of unidimensional pain assessment tools. Because of potential “oversimplification of the pain problem” when using only unidimensional pain assessment tools, experts often prefer to use a multidimensional pain assessment tool. Multidimensional tools offer the advantage of providing information on characteristics of pain, in addition to pain intensity. They may be provided in a visual, verbal, or written format. Examples of multidimensional assessment tools include the initial pain assessment tool, a brief pain inventory, the McGill pain questionnaire, a memorial pain assessment card, and a pain drawing.

Elderly patients, in particular, may have difficulty articulating an accurate description of their pain for several reasons. It is common for this population of patients to underreport their pain due to fear, cultural factors, or stoicism. Changes in the patterns of an individual’s activities of daily living, such as walking or participating in social activities, may be an indicator of unrelieved pain. Elderly patients should be assessed for hearing, vision, or verbal impairments that may affect the assessment technique. When assessing pain in elderly patients, ensure that enough time has been allocated to perform a thorough assessment and that the tool selected is amendable to the needs of the patient.4,8