Pain Management

Daniel Esso-Kwangue

Adult Nursing

Clinical : RNSG

Instructor: Jessica Hess, RN MSN

 Pain Management

Gerentology Consideration

Pain is an unpleasant sensory and emotional experience associated with actual or

potential tissue damage. It is a multidimensional, subjective experience common in the elderly

sixty-five years and above. Pain is not a consequence of aging. Pathology is involved; advanced

age is associated with an increased propensity for medical conditions associated with pain. In the

United States, the elderly constitute the segment of the society that is increasing at the fastest

rate. Approximately 50% community dwelling elders suffer from pain. Among the nursing home

residents, prevalence of pain is said to be 70% to 80%. Most of these people experience chronic

pain based on health disorders is common among this group. To promote comfort and pain relief,

effective pain management is essential. This involves thorough assessment of pain and pain

management strategies.

Pain is defined as whatever the client says it is and exists whenever the client says it does.

Self report is the most reliable indicator of pain. However, various assessment challenges occur

among the elderly. Davis and Srivastava (2003) reported that, “Cognitive impairment is one of

the major barriers of assessment in the elderly” (p 25). For these people, behavioral and

psychological changes may be the only indicators of pain. (Lewis, Heitkemper & Dirksen, 2004).

Behavioral patterns that signify pain include: moans, groans, facial expressions, noisy or labored

breathing, restlessness and body tension. Another barrier is that the elderly under report pain.
Fear of addiction, tolerance, side effects and the philosophy of the “good patient” are some of the

reasons why they do not adequately report pain. There are various tools available to assess pain.

Karmol (2008) states that, “The verbal Descriptor Scale was shown to be preferred by older

adults. This scale rates pain from mild pain to severe pain, to worst possible pain” (p1).

Some nursing consideration during assessment is avoidance of the word “pain”. Nurses are

sometimes advised to substitute the word pain for words such as ache, hurt, or sore. This is

because pain is subjective, personal and differs for each client. Therefore, nurses must rely on

what the client says. Cultural barriers, fixed income, sensory-perception, motor problems, co

morbidity, hearing and visual deficits are some barriers to effective pain management.

Successful pain management involves a combination of pharmacological and non-

pharmacological therapies, individualized to the patient. The first line of medication used for

pain relief is the non-opiates. These are administered for the mild to moderate pain. Tylenol is

the drug choice for musculoskeletal Pain. It is safe, works fast and has minimal side or adverse

effects. However, it should be cautiously used in elders with renal and hepatic diseases. (Horgas

2004). Non-steroidal anti-inflammatory drugs should be used cautiously because of the adverse

effect. Adjuvant drugs, non-opiates, have been known to have synergistic effect with analgesics.

Some of these include anti-depressant, muscle relaxant, anxiolytics and anti-convulsant. For

client safety considerations in the elderly, start low and go slow, anticipate, prevent and treat

adverse effects. Drugs like meperidine, methadone, propoxyphene and pentazoan should be
avoided in the elderly. Non-pharmacological therapies may include; relaxation techniques, music

therapy, massages and guided imagery.

Pain is a significant problem among the elderly. To help improve the elders’ quality of

life, health care providers should assess pain properly. Since Nurses play an important role in

pain management, implication for pain management for nursing practice include: proper

assessment, diagnosis and a complete knowledge of the underlying disease; individualize pain

management; effectively teach patient about the side effects of prescribed medication and

alternative therapies. Lastly, use standardized tools and proper documentation of finding measure

pain intensity, location, evaluate pain treatment and communicate these to other care providers.
 Reference

Davis, M., Srivastava, M. (2003). Demographics, assessment and management of pain in the

Elderly. Drugs and Aging, 20 (1), 23-57. Retrieved August 28, 2009, from CINAHL

with full text database.

Horgas, A. (2003). Pain management in the elderly adult. Journal of Infusion Nursing. 26 (3).

161-165. Retrieved August 28, 2009, from OVID with full text database.

Karmol, K. S. (May 10, 2008). Pain management in senior patients. The internet journal of

Health. P NA. Retrieved August 28, 2009, via Gale.

Lewis, S., Heitkemper, M., Dirksen, S., (2004). Medical-surgical nursing., (p 156) St. Louis:

Mosby, 7th ed.