The use of opioid medications and converting among them in the older adult population can often be challenging. Physiological changes in older adults may affect metabolism and cognitive abilities. Due to renally cleared metabolites, some opioids, such as morphine, should be used with caution among older adults. Others, such as meperidine, should never be used at all. When prescribing or changing opioids, the choice of the correct formulation, appropriate counselling, and close follow-up are essential for optimal pain management and in order to prevent adverse outcomes.
Key words: opioids, pain management, older adults, analgesia, opioid conversion.
Acute low back pain (ALBP) is a common condition that results in huge economic losses in the form of treatment and absenteeism (direct monitary loss for incurring the treatment and indirect monitary loss resulting from absence). It responds well to conservative therapy, but it often takes a period of between one and three months before improvement is seen. Acupuncture has its effect in pain reduction in various musculoskeletal conditions including ALBP. As is observed in the present case, this technique can reduce the recovery period in these patients and, thus, can improve the net outcome.
Key words: acute low back pain, acupuncture, conservative management, recovery period, analgesia.
Conan Kornetsky, PhD, Professor of Psychiatry and Pharmacology, Boston University School of Medicine, Boston, MA, USA.
There is a common belief, supported by considerable experimental reports, that the aged have higher pain thresholds than the young and are more responsive to the analgesic actions of opiate drugs. To a considerable degree this belief shapes pain treatment in aged adults. This article reviews the evidence for this belief and discusses why there is often a disparity between the reported alleviation of pain in older adults and the widely held belief that these individuals receive inadequate pain management. Among the issues discussed is the amount of control the patient really has in patient-controlled analgesia.
Key words: pain, aged, analgesia, pain measurement, morphine.
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