‘Start low, go slow’ strategy best for pain management in older people

Chronic pain is very common in older people and is often associated with other issues, such as depression, insomnia, social isolation and poor quality of life

Managing chronic pain effectively is essential but challenging, and it has been complicated by concerns about opioid abuse.

In a new study, researchers found that pain management can be safely optimized with a plan that balances the risks and benefits of treatments.

They found treating chronic pain is best achieved when drug strategies and nondrug therapies are used at the same time.

The research was conducted by a team at Mayo Clinic.

The team says chronic pain is generally not curable, but it can be managed with a systematic approach that begins with a thorough, function-based pain assessment followed by recognition and treatment of contributing conditions.

Then the emphasis should be on initial low-risk strategies to address pain, which typically include noninvasive, nonpharmacological options.

Virtually every patient can benefit from these low-risk options.

Though many medications used for managing chronic pain can have substantial adverse impacts, it’s important to keep in mind that older adults also are affected by a pain epidemic.

With judicious use, these medications, including opioids, are important tools for addressing chronic pain, which ultimately affects one’s function and independence.

The team offers a practical, step-by-step framework that can assist providers who are treating older adult patients with chronic pain:

Begin with a thorough assessment of pain, focusing on pain-related function.

Address associated conditions, such as depression and insomnia, at the same time.

Start with low-risk pain management strategies, including nondrug methods that get the patient actively involved in her or his own improvement.

Use higher-risk ― often pharmacologic ― strategies cautiously, when needed.

Frequently reassess and discontinue ineffective treatments.

The team also dispels some commonly held — and inaccurate or misleading — beliefs about the effects of pain medications on older adults, such as that opioid medications cause delirium and falls.

But they say opioids appear to increase the risk of fracture when a fall occurs. This may affect the pain management strategy for patients who have had falls or are at risk of falling.

The lead author of the study is Brandon Verdoorn, M.D., a geriatrician and internist at Mayo Clinic.

The study is published in Mayo Clinic Proceedings.

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