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Pain in Alzheimer’s Disease Patients Presented by: Marsha Farrell, BSN, RN-BC, CHPN Education Institute Coordinator Hospice Family Care 2008 Hospice Family Care
Objectives Learner will be able to : Give a definition of pain. List three misconceptions of pain management in elderly. Describe one research study showing patients with Alzheimer’s Disease (AD) experience pain. Use the Pain Assessment in Advanced Dementia (PAINAD) Scale. Describe four age-related changes affecting analgesics List two key pain principle for giving analgesics to elderly patients.
What is Pain?
“Whatever the patient says it is, existing whenever he/she says it does.” (McCaffery 1968)
“Unpleasant sensory and emotional experience associated with actual or potential tissue damage…it is always unpleasant and therefore, an emotional experience.” (Merskey, 1979)
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Why Talk About Pain?
Affects Quality of Life Issues
Causes of Pain in Elderly Population
Osteoarthritis Osteoporosis Peripheral neuropathy Peripheral vascular disease Angina Irritable bowel syndrome Post-herpetic neuralgia Cancer pain
Is Pain a Natural Part of Growing Old?
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Answer:
Misconceptions Regarding Pain in the Elderly McCaffery M, Pasero C: Pain: Clinical manual pp 675-676.
Pain
perception, or sensitivity, decreases with age.
If
the elderly patient does not report pain, he or she does not have pain.
If
an elderly patient appears to be occupied, asleep, or otherwise distracted from pain, he or she does not have pain.
Misconceptions Regarding Pain in the Elderly McCaffery M, Pasero C: Pain: Clinical manual pp 675-676.
The
potential side effects of opioids make them too dangerous to use to relieve pain in the elderly.
Elderly
patients report more pain as they
age. Alzheimer’s
patients and others with cognitive impairment do not feel pain, and their reports of pain are most likely invalid.
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Howard Florey Institute Study Degeneration of central pain processing in the brain OR Inability for AD patients to communicate the level of pain they experience.
Howard Florey Institute Study
Pain activity in AD patients just as strong as in healthy volunteers.
Both groups showed pain related activity in the brain’s medial and lateral pain systems
Pain activity lasted longer.
Misconceptions Regarding Pain in the Elderly McCaffery M, Pasero C: Pain: Clinical manual p. 37.
Cognitively impaired elderly patients are unable to use pain rating scales.
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McGill’s Present Pain Intensity Scale
Tips
Find a pain scale that is appropriate for the individual
Ask about pain more than once
Ask about pain in more than one way
Give adequate time to respond
When Self-report is not possible Assume
Pain Present (APP)
Look
for Behavioral Indicators
Give
Appropriate Analgesics
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PAINAD Scale Easy to Use
Includes five items:
1. 2. 3. 4. 5.
Breathing Negative vocalization Facial expression Body language Consolability
Patients observed for 5 minutes
Pain Assessment in Advanced Dementia (PAINAD)
Treatments
Pharmacotherapy
Non-pharmacological Strategies
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Age-induced Changes Influencing Analgesics
Absorption
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Distribution
How Does This Affect Drug Distribution?
Lipophilic drugs
Hydrophilic drugs
Metabolism
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Elimination
Age-induced Changes Influencing Analgesics
Tips For Safely Selecting Analgesics Use
analgesics with short half-lives and fewest side effects
Reduce
opioid dose 25%-50%
Titrate
slowly and monitor responses
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Tips For Safely Selecting Analgesics (cont.)
Be cautious with NSAIDS
Try acetaminophen for mild-moderate musculoskeletal pain.
Remember!
AD patients DO FEEL pain
AD patients CAN selfreport pain
Ask about pain more than once and in more than one way
Remember! (cont.)
Assume Pain Present
Use a behavioral scale like PAINAD
Use appropriate analgesics
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All Pain Deserves to Be Treated!
“To cure, sometimes; to alleviate, often; to comfort, always…” Aeschylus, a sixth century Greek dramatist 2008 Hospice Family Care
Resources 1 “Eldercare at Home,” Chapter 11-Pain, online: http://www.healthinaging.org/public_education/eldercare/ 11.xml (accessed 12 Dec 2007). 2 McCaffery M, Pasero C. Chapter 15 Pain in the Elderly. In: Pain: Clinical Manual, 2nd ed. St. Louis: Mosby, 1999; p 674-710. 3 “Geriatrics Society gives hints to fight off pain,” online: http://www.usatoday.com/news/health/aging/2002-05-09pain-tips.htm (accessed 12 Dec 2007). 4 “Alzheimer’s pain poorly treated, research shows,” online: http://www.emaxhealth.com/91/8775.html (accessed 6 Dec 2007).
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Resources 5 “Pain in Dementia: A Family and Caregivers Guide to Assessment and Treatment,” The American Geriatrics Society (AGS). 6 Scherder EJ. ”Low use of analgesics in Alzheimer’s disease: possible mechanisms,” AbstractPlus, online: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed& Cmd=ShowDetailView&TermTo... (accessed 6 Dec 2007). 7 “The Management of Persistent Pain in Older Persons: AGS Panel on Persistent Pain in Older Persons,” JAGS 50:S205-S224, 2002. 8 Warden V, Hurley A, and Volicer L. ” Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale,” JAMDA 2003; 4: 9-15 .
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