The Clinical journal of pain
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Review Comparative Study
Pharmacological management of persistent pain in older patients.
The purpose of this manuscript is to foster understanding of the unique attributes of aging as they relate to the treatment of persistent pain in order to improve care of older patients. ⋯ Adherence to contemporary clinical guidelines should serve to promote improved outcomes in older patients who suffer from ongoing and debilitating pain. Since outcomes studies are lacking, attention to principles of care as they apply to this particular population is advised. Since each patient's experience and response to drug therapy will be unique, individualized assessment that incorporates an analysis of the patient's physiological state (comorbidities and concurrent drug therapies), a determination of realistic goals, and monitoring of outcomes on a regular basis will provide the optimum balance between benefits and risks of analgesic pharmacotherapy.
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The purpose of this paper is to present salient principles of pain management in nursing homes and other long-term care settings. ⋯ Clinicians who care for patients receiving long-term care services must help establish a treatment plan that is reasonable given the limited resources and skills available in nursing homes and other long-term care facilities. Medication regimens should be simplified as much as possible. Contingency plans for pain management must be anticipated and made available so that delays do not occur during medication changes or dosage adjustments. Long-term care facilities need substantial support from physicians and other pain experts for education to continuously update their skills and knowledge. As the need for health systems for frail elderly persons continues to grow, it is important to provide comfort and effective pain control appropriate for these new settings.
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To better understand the nature of age differences in pain and nociception with the aging of the worlds' population. ⋯ The clinical implications are obvious; older persons are likely to be especially vulnerable to the negative impacts of pain and pain associated events.
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Review Comparative Study
Oral transmucosal fentanyl citrate in the outpatient management of severe cancer pain crises: a retrospective case series.
This retrospective chart review evaluated the efficacy of oral transmucosal fentanyl citrate (OTFC) in an outpatient cancer pain center for patients experiencing severe exacerbations of pain that exceed usual breakthrough pain levels. ⋯ Prior to OTFC treatment, all patients reported a mean pain intensity of 9.0 (SD = 1.2). After OTFC treatment, patients reported a mean intensity of 3.0 (SD = 1.4), a significant reduction in pain intensity (P < 0.001). In most cases, OTFC averted the need for an emergency center visit, parenteral opioids, and hospital admission, which suggests that OTFC may be an effective alternative over intravenous opioids to rapidly titrate analgesia in selected opioid-tolerant cancer patients experiencing severe pain.