Pain Issues and the Elderly - PowerPoint PPT Presentation

Loading...

PPT – Pain Issues and the Elderly PowerPoint presentation | free to view - id: 29b38-OGY4Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Pain Issues and the Elderly

Description:

OTC, non-opioid, and adjuvant medications ... Hydrocodone, oxycodone, tramadol (Ultram) Duration= 3-4 hour, (except may have longer relief with tramadol) ... – PowerPoint PPT presentation

Number of Views:315
Avg rating:3.0/5.0
Slides: 42
Provided by: annbe4
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Pain Issues and the Elderly


1
Pain Issues and the Elderly
  • Dr. Ann M. Berger, MSN, MD
  • Chief, Pain and Palliative Care
  • National Institutes of Health, Clinical
    Center

2
Acute vs. Chronic Pain
3
PathophysiologicMechanisms of Pain
4
Pain In the Elderly
  • Prevalence in population based studies in those
    65 are from 55-86.

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Step I Mild Pain
Step III
Step II
Step I
  • OTC, non-opioid, and adjuvant medications
  • Common medications
  • Aspirin, acetaminophen, ibuprofen, naproxen,
    Trilisate, COX-2 anti-inflammatories
  • ketorolac (Toradol) IV or PO (


10
Step II Moderate Pain
Step III
Step II
Step I
  • Opioid medication
  • With/without adjuvant analgesics
  • Common medications
  • Hydrocodone, oxycodone, tramadol (Ultram)
  • Duration 3-4 hour, (except may have longer
    relief with tramadol)
  • Common combination drugs Tylenol 3, Percocet,
    Roxicet, Oxycet, Vicodin, Lortab, Lorcet,
    Fioricet.

11
Step III Severe Pain
Step III
Step II
Step I
  • Short acting opioids
  • For acute pain, rescue dosing, or titration of
    long acting agents
  • Common Dilaudid, morphine sulfate IR, Roxanol,
    ACTIQ, oxycodone
  • Long acting
  • requires titration of short acting opioids
  • Provides consistent 24 hr therapeutic blood
    levels
  • 8-12 hrs Oxycontin, MS Contin, Oramorph,
    methadone (long t1/2 with shorter analgesic
    effect)
  • 48-72 hrs duration Duragesic

12
Opioids for Moderate to Severe Pain
Long Acting Morphine (MS Contin, Oramorph SR,
Kadian Oxycodone (Oxycontin) Fentanyl
(Duragesic) Methadone (Dolophine) Levorphanol
(Levo-Dromoran) Oxymorphone
13
Opioids for Moderate to Severe Pain
Short Acting Morphine (Roxanol, MSIR)
Oxycodone (Roxicodone, Oxy IR) Fentanyl
(Actiq) Hydromorphone (Dilaudid) Oxymorphone
14
Management of Common Opioid Side effects
Constipation - prophylactic use of laxatives
and stool softeners Nausea and vomiting -
neuroleptics, metoclopramide, cisapride,
antivertigenous drugs Sedation - discontinue
other CNS depressants - add psychostimulants
Respiratory depression - monitor if not severe
carefully titrate naloxone if severe
15
  • Tolerance
  • pharmacological need to increase dose to achieve
    the same effect over time in the absence of
    advancing disease. Tolerance is usually not
    problematic in chronic analgesic use.
  • Physical dependence
  • class-specific, predictable psycho-physiological
    reaction to sudden cessation or blocking of a
    drug. A tapering regimen will mitigate or stop
    withdrawal.

16
  • Addiction
  • overwhelming preoccupation with acquisition
  • use of drug for non-medicinal purposes
  • results in reduced quality of life and continued
    use despite harm.
  • Fewer than 0.1 of acute/chronic pain medication
    users develop addiction behaviors (Jick,
    Portenoy).
  • Pseudo-addiction
  • aberrant or illegal drug-seeking behavior similar
    to addiction that is due to unrelieved pain,
    which stops when adequate pain relief is achieved.

17
Neuropathic Pain-Adjuvant Analgesics
  • Tricyclic antidepressants
  • Anticonvulsants
  • Clonidine
  • Corticosteroids
  • Local anesthetics-Mexilitene
  • Ketamine
  • Baclofen

18
Nature of Pain
Neuropathic Mechanism
Psychosocial Influences
Somatic,Visceral Nociception
Pain
Psychological State and Traits
Total Pain
Spirituality
Suffering
Loss of Work
Social / Family Functioning
Physical Disability
Financial Concerns
Fear of Death
19
Emotional Pain hurts all over
  • Most common palliative care symptoms
  • Anxiety may present as sleeplessness, reluctant
    to be left alone or overt fright
  • Anticipatory Anxiety previous negative
    experience becomes overwhelming
  • Treatment relaxation imagery, acupressure,
    massage, music therapy, hypnosis. then maybe
    pharmacotherapy such as lorazepam, haloperidol

20
Emotional Pain
  • Care Giver Burden communication, communication,
    communication
  • Spirit of cooperation
  • Complex family dynamics emerge
  • Support to work through accumulated emotions
  • Can not take away all of the symptoms all the
    time
  • Imposing own expectations
  • Sense of presence is the very best medicine

21
Spirituality
  • The part of self where search for meaning takes
    place.
  • Distinction between religion and spirituality
  • Intimate connection with life through family,
    home, friends, leisure and work

22
It takes a nurturing interdisciplinary team to
practice the nature of palliative care
Thanatology Grief Counseling Family
Support, End-of-Life Issues Community
Transition
Recreational Therapy Relaxation Stress
Management Pet, Music, Art Therapy
Core Team Comprehensive
Assessment Coordinate Interventions Discharge
Planning
Co-morbidity Concomitant Disorder
Treatment Regimen
Rehabilitation Functional
Interventions Assistive Devices Energy
Conservation
Complementary Acupuncture/
Acupressure Tai Chi Trigger Point Release
Symptoms
Clinical Trials Protocol
Disease Process
Individuals Quality of Life
Social Work Socioeconomic Support
Community Resources Coping Skills
SpiritualMinistry Pastoral Presence Prayer
Hope Peace
Psychological Predisposition
Spirituality
Suffering
Roles and Relationships Isolation
Level of Function
Nutrition Satiety, Dysphagia
Nausea Intake Modification, TPN/Tube
Feedings
Pharmacy Pharmacological
Counseling Equianalgesia Adjuvant Agents
Economic Burden
Emotional State
Grief
23
MassageA simple form of therapy with the
potential of restoring physical, emotional
spiritual well-being
  • Relaxation
  • Eases muscular tension, stiffness pain
  • Promotes communication
  • Lessens feeling of isolation, tactile stimulation
  • Replenishes energy
  • Improves plasma lymphatic circulation
  • Strengthens tones muscles
  • Stimulates or calms functions of the nervous
    system

24
Electro Therapeutic Point Stimulator
  • Applies concentrated low frequency stimulation to
    acutherapy points, biochemical response,
    contracted motor trigger points
  • Used to provide immediate or chronic pain relief
    and decrease muscle tonicity

25
Transcutaneous Electrical Nerve Stimulation (TENS)
  • Blocks pain by directing a stimulating current
    into local nerves
  • Uses high-frequency signals
  • At low frequencies, reduces pain by stimulating
    acupuncture and trigger points

26
Methods of RelaxationUsed to modify behavior,
perception, feelings or internal psychological
state
  • Passive Progressive
  • Muscle Relaxation
  • Stretching/Movement
  • Affirmations
  • Desensitization
  • Centering
  • Breathing
  • Meditation
  • Guided imagery
  • Visualization

27
Yoga
  • Focuses on the physical mental practice of
    binding mind, body spirit with controlled
    movement
  • Used to ease muscle tension, improve flexibility,
    strength, balance endurance
  • increasing body awareness

28
Vibroacoustic Chair
  • Delivers auditory tactile vibrations to the
    body to areas of greatest bone conductivity
  • Used to relieve symptom burden

29
Biofeedback
  • Provides guidance for the validation of direct
    feedback to bodily processes (peripheral body
    temperature, EMG, skin conduction)
  • Used for relaxation and self-regulation

30
Hypnosis
  • Develops a purposeful altered state of
    consciousness through focused attention
  • (responsiveness to suggestion, ability to
    dissociate through time space)
  • Used to accomplish difficult psychophysical
    changes

31
Acupuncture
  • Therapeutic insertion of needles in patterns at
    acupuncture points to encourage the flow of
    energy (qi)
  • Manual or electrical stimulation used to elicit
    local generalized effects

32
Acupressure
  • Ancient Chinese healing method that involves
    applying pressure to one or more of the 14
    meridian pointsareas that carry energy
    throughout the body
  • Meridians start at the finger tips, connect to
    the brain, then to the organ associated with the
    specific meridian

33
Reiki
  • Utilizes a universal energy healing system that
    is applicable to all purposes, conditions or
    situations
  • Used for whole body energy balancing, healing,
    well-being maintaining immune system integrity

34
Finger Labyrinth
  • A replica of a walking Labyrinth, used as a
    spiritual tool for meditation with the aims of
  • Releasing as you enter, quiet the mind by
    focusing on your breathing sensing your finger
    on the path
  • Receiving pause in the center, reflect where you
    are in your life ask for guidance
  • Renewal as you exit, reconnect with universal
    life reflect on a positive quality you want to
    bring into your life, allowing the guidance to
    lead you

35
Mandala
  • An artistic design often used in meditation for
    centering, focusing contemplation
  • A spiritual tool for creating symbolism, relating
    to the relationship of ones soul to the universe
  • A means that allows the patient to explore
    self-understanding, as a path to healing
  • - the center of the circle represents the most
    important thing in your life
  • - surround the center with concentric circles,
    using symbols for your life symbols of that
    which threatens or protects you
  • - the outer circle represents the absolute
    boundary of the universe as you know it

36
(No Transcript)
37
Animal Assisted Therapy
  • Designed for goal-directed interventions by
    companion animals from the National Capital
    Therapy Dogs
  • Used to reduce the negative impact of a medical
    environment, improve tactile stimulation,
    maintain/improve social skills increase
    physical movement

38
Art Therapy
  • A supportive venue of psychotherapy that
  • enables the patient to break the barriers of
  • inhibition, while promoting emotional
  • expression healing through non-verbal
  • means.

39
Music
  • Incorporates active passive experiences of
    listening, participation, life review, lyric
    analysis, song writing and toning .
  • Toning is the elongation of a note/tone from
    the voice, aimed at a specific area of the body.
    The body has a relaxation response when toning is
    applied to certain conditions such as localized
    pain, nausea or constipation. It also has a
    soothing effect for emotional pain suffering.
  • Used to achieve/maintain optimal physical,
    emotional, spiritual social well-being, as well
    as enhancing communication

40
Considerations in Complementary Therapies
  • Initiate one modality at a time
  • Re-evaluate for effectiveness
  • Therapies may have interactions synergistic use
    of Reiki and Hypnosis but not Reiki and
    Acupuncture
  • Complimentary therapies often require a series of
    treatments, such as 6 to 12 sessions of
    Acupuncture

41
Take Back to Practice
  • Palliative Intervention
  • Early
  • Available
  • Integrative
  • Reassurance
  • To our patient-Heroes disguised as ordinary
    people going on an extraordinary journey !
  • and they lived at peace each day they had
About PowerShow.com