Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
Assessment and Management of
Pain in the Elderly
Pain
An unpleasant sensory and emotional experience associated
with actual or potential tissue damage, or described in ter...
• Pain is distressing experience associated with actual
or potential tissue damage with sensory, emotional,
cognitive and ...
An unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of...
• It is unquestionably a sensation in a part or parts of the body,
but it is also always unpleasant and therefore also an
...
Louisa Jones and John J. Bonica. It was taken in 1986 in Stockholm.
Professor John Bonica, chair of the Department of Anes...
John Loeser , in his model of pain, proposes four pain dimensions: nociception, pain,
suffering and pain behaviour.
Physiology and Anatomy of Pain
• Nociceptors : nociceptors, which derives from the
Latin word meaning injury.
• Ad (A delt...
• The fast-sharp pain signals are elicited by either mechanical
or thermal pain stimuli. They are transmitted in the perip...
Nociceptors release the neurotransmitter (substance P or glutamate).
• Physiological pain: The pain response to high-intensity stimuli is
transient if the tissue damage is prevented by a simp...
Pathological pain
• This results from sensitization of
the nerves in the periphery and
the spinal cord.
• This can occur a...
Central sensitisation
• Central sensitisation describes the circumstances in
which there is an enhancement of the function...
• Example, gentle stroking can become pain – this is
termed allodynia.
• Furthermore, an exaggerated response to
lowthresh...
The pain gate theory
Second World Congress on Pain,
Montreal, 1978. Ronald Melzack, Chair
of the Local Arrangements Commit...
Aδ and C fibres synapse within the dorsal horn of the spinal cord
with both transmission fibres and interneurons
Rubbing t...
Type of pain
• Acute pain
• Chronic pain
• Nociceptive pain
• Neuropathic pain
• Although no universally accepted definition exists for chronic
pain, it is often defined as pain that persists beyond th...
Older people
• With ageing, sensory signals are slower, and the warning system of
pain may become less effective.
• Pain m...
• Women are generally more likely to report chronic pain than
men (Molton IR, Terrill AL.,2014).
• Consequences of this pa...
Elements of a comprehensive
geriatric pain assessment
Sensory:
• What does it feel like?
• What words come to mind?
Emotio...
Attitudes and beliefs
• Do you have any thoughts or opinions about specific pain
treatments that you believe would be impo...
Assessing pain in older patients with major
cognitive impairment
Require modified approaches to assessment.
• Attempt to o...
Pain Assessment
• Geriatric pain assessment is typically followed by a good
history and physical exam.
• The elderly can e...
• A comprehensive assessment of pain requires
• pain history,
• physical examination,
• specific diagnostic tests
Pain history
• A general medical history is an important part of the pain history, often
revealing important aspects of co...
(i) Where is the pain?
(ii) How intense is the pain?
(iii) Description of the pain (e.g. burning, aching,
stabbing, shooti...
(viii) How does your pain affect
(a) your sleep?
(b) your physical functions?
(c) your ability to work?
(d) your economy?
...
(ix) What treatments have you received? Effects of
treatments? Any adverse effects?
(x) Are you depressed?
(xi) Are you wo...
Physical examination
(i) General physical examination
(ii) specific pain evaluation
(iii) neurological examination;
(iv) m...
Specific diagnostic studies
(i) Quantitative sensory testing (QST)
with specific and well-defined
sensory stimuli for pain...
Pain Assessment Scales
• Verbal Descriptor Scales (VDS),
• Verbal Rating Scales (VRS)
• Visual Analogue Scales (VAS)
• Num...
Risk factors include advancing age,
• female sex
• lower socioeconomic status,
• Lower educational level,
• obesity, tobac...
Verbal Rating Scales (VRS)
• The 0-to-3 Verbal Rating Scale (VRS)
Brief Pain Inventory (Short Form)
1991 Charles S. Cleeland, PhD Pain Research Group
The Brief Pain Inventory (BPI)
• The first version of our pain measure was the
Wisconsin Brief Pain Questionnaire (BPQ; Da...
The McGill Pain Questionnaire and the
short-form McGill Pain Questionnaire
• The McGill Pain Questionnaire (MPQ) and the s...
Visual Analogue Scale (VAS)
• In clinical and research settings, VAS has proven to be a useful
measurement of pain because...
The Numeric Pain Rating Scale
Wong — Baker Faces Pain Rating Scale.
• This tool was originally created with children for children to help them
communica...
Verbal Descriptor Scale (Pain Thermometer)
An advantage of VDS is that
most elderly patients prefer
it because of its simp...
Role of Emerging Technologies in Geriatric
Pain Management
• Geographic distance from health care centers.
• transportatio...
Evaluation of the iPhone Pain Assessment
Application for People with Dementia
• University of Greenwich collaborated with ...
Pharmacological management of pain
• Adverse drug reactions in the elderly are a significant
risk, but pharmacologic inter...
• Paracetamol can be used in the older person via a
variety of routes, from oral through to intravenous.
• Paracetamol sho...
Nonsteroidal anti-inflammatory drugs
(NSAIDS)
• NSAIDs reduce pain and inflammation by inhibiting
the production of cyclo-...
Pharmacological management of
moderate pain
• Codeine:
• Tramadol
Pharmacological management of
moderate to severe pain
• Opioids
• Local anaesthetics
• Epidural and spinal anaesthesia:
• The optimal approach to the management of pain in
older persons considers pharmacological and non-
pharmacological optio...
Acute pain management
in the older person
Non-pharmacological management of pain
• Superficial or topically applied cold t...
• Fibromyalgia is characterised by persistent, widespread pain;
sleep problems; and fatigue.
• Transcutaneous electrical n...
• Objectives: To assess the analgesic efficacy and adverse events
of TENS alone or added to usual care (including exercise...
• Objectives: To determine the analgesic effectiveness of TENS
versus placebo (sham) TENS, TENS versus usual care, TENS
ve...
• Data collection and analysis: Two review authors
independently screened all database search results and
identified paper...
• Authors’ conclusions:
• The quality of the evidence was very low meaning
and unable to confidently state whether TENS is...
Exercise and physical activity
• Increasing and maintaining physical activity is
important in the management of persistent...
Management of chronic pain in older adults
Objectives:
• Effectiveness of different physical activity and exercise
interventions in reducing pain severity and its im...
• Extracted data for (1) self-reported pain severity, (2)
physical function (objectively or subjectively measured),
(3) ps...
• Pain conditions included rheumatoid arthritis, osteoarthritis,
fibromyalgia, low back pain, intermittent claudication,
m...
Authors’ conclusions:
• There were some favourable effects in reduction in pain
severity and improved physical function, t...
Nonsurgical Management of Osteoarthritis Knee
Pain in the Older Adult
• Older adults opting for knee replacement are likel...
Muscle mass and strength are lost in
the natural aging process with a
decline in strength appreciable even
when muscle mas...
Massage
• Massage therapy has a long history of demonstrating
positive effects on musculoskeletal pain and chronic
pain in...
Psychological interventions
• The biopsychosocial model reinforces how
psychological factors may influence the way in
whic...
Cognitive behavioural therapy
• Cognitive and behavioural therapies use a broad
range of psychological techniques to alter...
Guided imagery and biofeedback
• Guided imagery is an approach whereby the
attention is focused on sights, sounds, music
a...
Self-management of pain
• Self-management covers a wide range of techniques,
including relaxation, coping strategies, exer...
References
• Molton IR, Terrill AL. Overview of persistent pain in older
adults. Am Psychol. 2014;69:197–207.
• Kaye AD, B...
• . Fang M, Noiseux N, Linson E, et al. The effect of
advancing age on total joint replacement outcomes.
Geriatr Orthop Su...
Pain by sunil
Pain by sunil
Pain by sunil
Pain by sunil
Pain by sunil
Pain by sunil
Pain by sunil
Pain by sunil
Pain by sunil
Prochain SlideShare
Chargement dans…5
×

sur

Pain by sunil Slide 1 Pain by sunil Slide 2 Pain by sunil Slide 3 Pain by sunil Slide 4 Pain by sunil Slide 5 Pain by sunil Slide 6 Pain by sunil Slide 7 Pain by sunil Slide 8 Pain by sunil Slide 9 Pain by sunil Slide 10 Pain by sunil Slide 11 Pain by sunil Slide 12 Pain by sunil Slide 13 Pain by sunil Slide 14 Pain by sunil Slide 15 Pain by sunil Slide 16 Pain by sunil Slide 17 Pain by sunil Slide 18 Pain by sunil Slide 19 Pain by sunil Slide 20 Pain by sunil Slide 21 Pain by sunil Slide 22 Pain by sunil Slide 23 Pain by sunil Slide 24 Pain by sunil Slide 25 Pain by sunil Slide 26 Pain by sunil Slide 27 Pain by sunil Slide 28 Pain by sunil Slide 29 Pain by sunil Slide 30 Pain by sunil Slide 31 Pain by sunil Slide 32 Pain by sunil Slide 33 Pain by sunil Slide 34 Pain by sunil Slide 35 Pain by sunil Slide 36 Pain by sunil Slide 37 Pain by sunil Slide 38 Pain by sunil Slide 39 Pain by sunil Slide 40 Pain by sunil Slide 41 Pain by sunil Slide 42 Pain by sunil Slide 43 Pain by sunil Slide 44 Pain by sunil Slide 45 Pain by sunil Slide 46 Pain by sunil Slide 47 Pain by sunil Slide 48 Pain by sunil Slide 49 Pain by sunil Slide 50 Pain by sunil Slide 51 Pain by sunil Slide 52 Pain by sunil Slide 53 Pain by sunil Slide 54 Pain by sunil Slide 55 Pain by sunil Slide 56 Pain by sunil Slide 57 Pain by sunil Slide 58 Pain by sunil Slide 59 Pain by sunil Slide 60 Pain by sunil Slide 61 Pain by sunil Slide 62 Pain by sunil Slide 63 Pain by sunil Slide 64 Pain by sunil Slide 65 Pain by sunil Slide 66 Pain by sunil Slide 67 Pain by sunil Slide 68 Pain by sunil Slide 69 Pain by sunil Slide 70 Pain by sunil Slide 71 Pain by sunil Slide 72 Pain by sunil Slide 73 Pain by sunil Slide 74 Pain by sunil Slide 75 Pain by sunil Slide 76 Pain by sunil Slide 77 Pain by sunil Slide 78 Pain by sunil Slide 79
Prochain SlideShare
What to Upload to SlideShare
Suivant
Télécharger pour lire hors ligne et voir en mode plein écran

1 j’aime

Partager

Télécharger pour lire hors ligne

Pain by sunil

Télécharger pour lire hors ligne

assessment and management of pain, physiotherapy pain management,

Livres associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

Livres audio associés

Gratuit avec un essai de 30 jours de Scribd

Tout voir

Pain by sunil

  1. 1. Assessment and Management of Pain in the Elderly
  2. 2. Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage., “or described in terms of such damage”. This was intended to acknowledge complaints of people experiencing pain without evidence of tissue stress or damage, despite thorough investigation (International Association for the Study of Pain).
  3. 3. • Pain is distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components. • (Amanda C de C Williams . Pain. 2016 Nov)
  4. 4. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: • The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. • Pain is always subjective. • Each individual learns the application of the word through experiences related to injury in early life. • Biologists recognize that those stimuli which cause pain are liable to damage tissue. • Accordingly, pain is that experience we associate with actual or potential tissue damage.
  5. 5. • It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. • Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. • Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. This definition officially adapted in 1979 was a slightly revised version of a formulation first proposed by Harold Merskey. International Association for the Study of Pain (IASP) , 1994 publication
  6. 6. Louisa Jones and John J. Bonica. It was taken in 1986 in Stockholm. Professor John Bonica, chair of the Department of Anesthesiology at the University of Washington in Seattle and author of the groundbreaking book, The Management of Pain, published in 1953 by Lea & Febiger.
  7. 7. John Loeser , in his model of pain, proposes four pain dimensions: nociception, pain, suffering and pain behaviour.
  8. 8. Physiology and Anatomy of Pain • Nociceptors : nociceptors, which derives from the Latin word meaning injury. • Ad (A delta) and C fibres (Cesare and McNaughton, 1997) • Pain arises from chemical, thermal or mechanical stimulus of the small-diameter sensory afferent fibres found in the tissue.
  9. 9. • The fast-sharp pain signals are elicited by either mechanical or thermal pain stimuli. They are transmitted in the peripheral nerves to the spinal cord by small type Aδ fibers at velocities between 6 and 30 m/sec. • Conversely, the slow-chronic type of pain is elicited mostly by chemical types of pain stimuli but sometimes by persisting mechanical or thermal stimuli. This slow-chronic pain is transmitted to the spinal cord by type C fibers at velocities between 0.5 and 2 m/sec.
  10. 10. Nociceptors release the neurotransmitter (substance P or glutamate).
  11. 11. • Physiological pain: The pain response to high-intensity stimuli is transient if the tissue damage is prevented by a simple spinal flexion reflex arc (Willer, 1979). Consider striking a match and touching the flame with your fingers you would drop the match instantly before damage could occur. • The speed with which this reflex occurs prevents deep tissue damage and allows only a brief moment of discomfort. This is caused by a simple spinal reflex mediated by the high-intensity thermal stimulation of small sensory nerve endings in fingers.
  12. 12. Pathological pain • This results from sensitization of the nerves in the periphery and the spinal cord. • This can occur as a result of inflammation. • Peripheral nerve endings are made more sensitive to noxious stimuli through tissue damage, action of local hormones such as prostaglandins, histamine, serotonin and bradykinin, and also by direct nerve damage – this is called peripheral sensitization.
  13. 13. Central sensitisation • Central sensitisation describes the circumstances in which there is an enhancement of the function of neurons involved in nociception • hypersensitivity to stimuli, • responsiveness to non-noxious stimuli • Increased pain response evoked by stimuli outside the area of injury, an expanded receptive field. • As a result the nerve fibres of the central nervous system begin to respond to non-noxious stimuli such as gentle touch as if they were pain impulses.
  14. 14. • Example, gentle stroking can become pain – this is termed allodynia. • Furthermore, an exaggerated response to lowthreshold noxious stimuli can occur (hyperalgesia).
  15. 15. The pain gate theory Second World Congress on Pain, Montreal, 1978. Ronald Melzack, Chair of the Local Arrangements Committee. The pain gate was proposed by Melzack and Wall back in 1965. It is the most widely accepted theory of pain, and explains a great many of the pain phenomena. The plasticity of the nervous system – its ability to become desensitized and sensitized also adds an extra dimension.
  16. 16. Aδ and C fibres synapse within the dorsal horn of the spinal cord with both transmission fibres and interneurons Rubbing the affected area will also stimulate the low-threshold Aβ fibres which in turn synapse with the inhibitory interneuron which decreases sensitivity of the transmission neuron to the nociceptors’ outputs.
  17. 17. Type of pain • Acute pain • Chronic pain • Nociceptive pain • Neuropathic pain
  18. 18. • Although no universally accepted definition exists for chronic pain, it is often defined as pain that persists beyond the expected time of healing (typically 12 weeks) and may or may not be associated with an identifiable cause or actual tissue damage. (IASP taxonomy. 2012).
  19. 19. Older people • With ageing, sensory signals are slower, and the warning system of pain may become less effective. • Pain may be underreported as some elderly patients incorrectly believe that pain is a normal process of aging. • Approximately 66 % of people over the age of 65 report chronic pain (Molton IR, Terrill AL.,2014). • Most common types of pain in elderly adults are low back or neck pain (65 %), musculoskeletal pain (40 %), peripheral neuropathic pain (40 %), and chronic joint pain (20 %). (Denard PJ., et al. 2010) • They do not seek medical management because they falsely believe their chronic pain will not benefit from treatment. (Kaye AD., et al. 2010).
  20. 20. • Women are generally more likely to report chronic pain than men (Molton IR, Terrill AL.,2014). • Consequences of this pain include impaired activities of daily living, depression, sleep disruption, cognitive impairment and a burden on health care costs.
  21. 21. Elements of a comprehensive geriatric pain assessment Sensory: • What does it feel like? • What words come to mind? Emotional impact: • Has pain affected your mood, energy level? Functional impact: • Has pain affected your ability to do every day activities? Sleep: • Has pain affected your sleep?
  22. 22. Attitudes and beliefs • Do you have any thoughts or opinions about specific pain treatments that you believe would be important for me to know? Coping styles: • What things do you do to help you cope with your pain? Treatment expectations and goals: • What do you think is likely to happen with the treatment I have recommended? Resources: • Is there anyone at home or in the community that you can turn to for help and support when your pain is really bad?
  23. 23. Assessing pain in older patients with major cognitive impairment Require modified approaches to assessment. • Attempt to obtain self report data. • Search for potential causes of the pain, • Observing patient behaviour (for example, facial expressions, vocalizations, guarding), • Obtaining proxy data from family members or caregivers who know the patient well and can report on whether changes in behaviour or activity are very different from baseline, • Conducting an analgesic trial to see whether the behaviour resolves with treatment.
  24. 24. Pain Assessment • Geriatric pain assessment is typically followed by a good history and physical exam. • The elderly can experience multiple pain syndromes from different areas of the body and this should be considered while contemplating a differential diagnosis for pain.
  25. 25. • A comprehensive assessment of pain requires • pain history, • physical examination, • specific diagnostic tests
  26. 26. Pain history • A general medical history is an important part of the pain history, often revealing important aspects of co-morbidities contributing to a complex pain condition. • The specific pain history must clarify location, intensity, pain descriptors, temporal aspects, and possible pathophysiological and aetiological issues. • It is more than just a sensory event. • It has emotional responses to pain. • Behaviors manifested in response to pain by patients and their family members or caregivers) • Attitudes and beliefs about pain. • As well as sensory components (for example, quality, location, temporal pattern).
  27. 27. (i) Where is the pain? (ii) How intense is the pain? (iii) Description of the pain (e.g. burning, aching, stabbing, shooting, throbbing, etc). (iv) How did the pain start? (v) What is the time course of the pain? (vi) What relieves the pain? (vii) What aggravates the pain?
  28. 28. (viii) How does your pain affect (a) your sleep? (b) your physical functions? (c) your ability to work? (d) your economy? (e) your mood? (f ) your family life? (g) your social life? (h) your sex life?
  29. 29. (ix) What treatments have you received? Effects of treatments? Any adverse effects? (x) Are you depressed? (xi) Are you worried about the outcome of your pain condition and your health? (xii) Are you involved in a litigation or compensation process?
  30. 30. Physical examination (i) General physical examination (ii) specific pain evaluation (iii) neurological examination; (iv) musculoskeletal system examination (v) assessment of psychological factors.
  31. 31. Specific diagnostic studies (i) Quantitative sensory testing (QST) with specific and well-defined sensory stimuli for pain thresholds and pain tolerance. (ii) Diagnostic nerve blocks test. (iii) Pharmacological tests. (iv) Conventional radiography, computerized tomography, magnetic resonance imaging.
  32. 32. Pain Assessment Scales • Verbal Descriptor Scales (VDS), • Verbal Rating Scales (VRS) • Visual Analogue Scales (VAS) • Numerical Rating Scales (NRS) • McGill Pain Questionnaire (MPQ) • Brief Pain Inventory (Short Form)
  33. 33. Risk factors include advancing age, • female sex • lower socioeconomic status, • Lower educational level, • obesity, tobacco use, • history of injury, • History of a physically strenuous job, • Childhood trauma • Depression • Anxiety
  34. 34. Verbal Rating Scales (VRS) • The 0-to-3 Verbal Rating Scale (VRS)
  35. 35. Brief Pain Inventory (Short Form) 1991 Charles S. Cleeland, PhD Pain Research Group
  36. 36. The Brief Pain Inventory (BPI) • The first version of our pain measure was the Wisconsin Brief Pain Questionnaire (BPQ; Daut & Cleeland, 1982; Daut, Cleeland, & Flanery, 1983).
  37. 37. The McGill Pain Questionnaire and the short-form McGill Pain Questionnaire • The McGill Pain Questionnaire (MPQ) and the short-form MPQ (SF-MPQ) evaluate sensory, affective–emotional, evaluative, and temporal aspects of the patient’s pain condition. • The SF-MPQ consists of 11 sensory (sharp, shooting, etc.) and four affective (sickening, fearful, etc.) verbal descriptors. • The patient is asked to rate the intensity of each descriptor on a scale from 0 to 3. • Three pain scores are calculated: the sensory, the affective, and the total pain index. Patients also rate their present pain intensity on a 0 – 5 scale and a VAS
  38. 38. Visual Analogue Scale (VAS) • In clinical and research settings, VAS has proven to be a useful measurement of pain because of its simplicity, reliability, and ease of use (Kaye AD, Baluch A, Scott JT., 2010).
  39. 39. The Numeric Pain Rating Scale
  40. 40. Wong — Baker Faces Pain Rating Scale. • This tool was originally created with children for children to help them communicate about their pain. Now the scale is used around the world with people ages 3 and older, facilitating communication and improving assessment so pain management can be addressed. ©1983 Wong-Baker FACES Foundation. www.WongBakerFACES.org
  41. 41. Verbal Descriptor Scale (Pain Thermometer) An advantage of VDS is that most elderly patients prefer it because of its simplicity of use, since it is suitable for even mild to moderately impaired patients.
  42. 42. Role of Emerging Technologies in Geriatric Pain Management • Geographic distance from health care centers. • transportation services and increased mobility difficulties. • Significant cost savings in intervention delivery but also improved quality of life and feelings of control among patients. Rachael Elizabeth Docking, PhD, MA (Hons 2016 Published by Elsevier Inc.
  43. 43. Evaluation of the iPhone Pain Assessment Application for People with Dementia • University of Greenwich collaborated with the Computing and Mathematical Sciences department to develop an iPhone pain assessment app. (Docking RE., et al. 2015)
  44. 44. Pharmacological management of pain • Adverse drug reactions in the elderly are a significant risk, but pharmacologic intervention for pain management remains the principal treatment modality for pain. • Paracetamol: most popular and most commonly used analgesic and antipyretic drugs around the world. • It was found by chance.
  45. 45. • Paracetamol can be used in the older person via a variety of routes, from oral through to intravenous. • Paracetamol should be regarded as the first-line analgesic for mild to moderate pain and as an important component of multimodal analgesia in the management of moderate to severe pain. • Co-administration of an NSAID or opioid, unless contraindicated, with paracetamol may significantly improve its analgesic effects Provenance and Peer review: Commissioned; Peer reviewed; Accepted for publication April 2015.
  46. 46. Nonsteroidal anti-inflammatory drugs (NSAIDS) • NSAIDs reduce pain and inflammation by inhibiting the production of cyclo-oxygenase (COX) isoenzymes. These enzymes are prostaglandins. • Prostaglandins are produced at sites of injury or damage, and cause pain and inflammation. • By blocking the effect of COX enzymes, fewer prostaglandins are produced, which means that pain and inflammation are eased. • NSAIDs including diclofenac and naproxen are considered to be non-selective COX inhibitors.
  47. 47. Pharmacological management of moderate pain • Codeine: • Tramadol
  48. 48. Pharmacological management of moderate to severe pain • Opioids • Local anaesthetics • Epidural and spinal anaesthesia:
  49. 49. • The optimal approach to the management of pain in older persons considers pharmacological and non- pharmacological options • Balances pain relief with side effects of therapy. • Pharmacological management is made more difficult because of age-related physiological changes, co- morbidity, polypharmacy, disability and frailty. 37th Annual Scientific Meeting of the Australian Pain Society, in Adelaide South Australia 9-12 April, 2017
  50. 50. Acute pain management in the older person Non-pharmacological management of pain • Superficial or topically applied cold therapy is used to reduce inflammation, pain, and swelling and to increase pain tolerance. • Cold application decreases skin and joint temperature, decreases blood flow and has a direct analgesic effect. • The first mention of cold treatment dates back to ancient Egypt, 2500 BC. • Hippocrates also recommended the use of cold water, flour mush, ice and snow to treat fresh injuries. Provenance and Peer review: Commissioned; Peer reviewed; Accepted for publication April 2015.
  51. 51. • Fibromyalgia is characterised by persistent, widespread pain; sleep problems; and fatigue. • Transcutaneous electrical nerve stimulation (TENS) is the delivery of pulsed electrical currents across the intact surface of the skin to stimulate peripheral nerves and is used extensively to manage painful conditions. • TENS reduces pain during movement in some people so it may be a useful adjunct to assist participation in exercise and activities of daily living.
  52. 52. • Objectives: To assess the analgesic efficacy and adverse events of TENS alone or added to usual care (including exercise) compared with placebo (sham) TENS, for fibromyalgia in adults. • Search methods: Searched the following electronic databases up to 18 January 2017: CENTRAL (CRSO); MEDLINE (Ovid); Embase (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS; PEDRO; Web of Science (ISI); AMED (Ovid); and SPORTDiscus (EBSCO). • Selection criteria: included randomised controlled trials (RCTs) or quasi-randomised trials. TENS administered using noninvasive techniques, TENS administered as a sole treatment or TENS in combination with other treatments,. • Main results: There was insufficient high-quality evidence to support or refute the use of TENS for fibromyalgia.
  53. 53. • Objectives: To determine the analgesic effectiveness of TENS versus placebo (sham) TENS, TENS versus usual care, TENS versus no treatment and TENS in addition to usual care versus usual care alone in the management of neuropathic pain in adults. • Search methods: Searched CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, Web of Science, PEDro, LILACS (up to September 2016) and various clinical trials registries. • Selection criteria: Included randomised controlled trials where TENS was evaluated in the treatment of central or peripheral neuropathic pain
  54. 54. • Data collection and analysis: Two review authors independently screened all database search results and identified papers requiring full-text assessment. • Main results:We included 15 studies with 724 participants • Found a range of treatment protocols in terms of duration of care, TENS application times and intensity of application. • Briefly, duration of care ranged from hour days through to three months. • Similarly, variation of TENS application times; from 15 minutes up to hourly sessions applied four times daily.
  55. 55. • Authors’ conclusions: • The quality of the evidence was very low meaning and unable to confidently state whether TENS is effective for pain control in people with neuropathic pain.
  56. 56. Exercise and physical activity • Increasing and maintaining physical activity is important in the management of persistent pain in older people. • There is also RCT evidence of improvement in function and pain with exercise for older people over 65 with chronic pain. • Persistent pain is also a strong risk factor for falls in older people • Exercise should involve strengthening, flexibility, endurance and balance
  57. 57. Management of chronic pain in older adults
  58. 58. Objectives: • Effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use • The evidence for any adverse effects or harm associated with physical activity and exercise interventions. Methods: • Searched the Cochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs).
  59. 59. • Extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death. Main results: • Included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.
  60. 60. • Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. • Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.
  61. 61. Authors’ conclusions: • There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small to- moderate effect, and were not consistent across the reviews. • The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life.
  62. 62. Nonsurgical Management of Osteoarthritis Knee Pain in the Older Adult • Older adults opting for knee replacement are likely to suffer longer hospital stays and higher risks of both intensive care unit admission and postoperative complications as compared with younger patients. (Fang M, Noiseux N, Linson E, et al. 2015) NONPHARMACOLOGIC TREATMENT OPTIONS • Focus on exercise and achieving a healthy weight. • A 7% to 10% weight loss in obese elderly patients with symptomatic knee osteoarthritis should be the aim to achieve pain relief. • Exercise should be tailored to the individual functional level with progressive programs favored.
  63. 63. Muscle mass and strength are lost in the natural aging process with a decline in strength appreciable even when muscle mass is maintained. Strength training is one mechanism to achieve this end
  64. 64. Massage • Massage therapy has a long history of demonstrating positive effects on musculoskeletal pain and chronic pain in general. • Proposed that massage can increase serotonin and dopamine levels, and enhance the local blood flow while ‘closing the pain gate’. • Ten minutes of slow stroke back massage has been shown to reduce shoulder pain and anxiety in older adults with a stroke, and this effect continues for 3 days after the massage. (Mok E, Woo CP. 2004) British Geriatric Society (2013)
  65. 65. Psychological interventions • The biopsychosocial model reinforces how psychological factors may influence the way in which people interpret, respond to and cope with pain.
  66. 66. Cognitive behavioural therapy • Cognitive and behavioural therapies use a broad range of psychological techniques to alter dysfunctional ways of thinking, modify beliefs and attitudes and increase a person’s control over pain and how they interpret and manage this. • This intervention consists of a comprehensive initial evaluation of a range of domains, including level of dementia, emotional distress and pain. • Therapist worked collaboratively with the residents, their families and others involved in their care British Geriatric Society (2013)
  67. 67. Guided imagery and biofeedback • Guided imagery is an approach whereby the attention is focused on sights, sounds, music and words to create feelings of empowerment and relaxation. • Relaxation and guided imagery may be effective strategies for pain management British Geriatric Society (2013)
  68. 68. Self-management of pain • Self-management covers a wide range of techniques, including relaxation, coping strategies, exercise, adaptations to activities and education about pain and its effects. (Kemp CA 2005) • By definition, the person with pain takes the lead role in carrying out the intervention, independently or with varying levels of support from health professionals.
  69. 69. References • Molton IR, Terrill AL. Overview of persistent pain in older adults. Am Psychol. 2014;69:197–207. • Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179–87. • Denard PJ, Holton KF,Miller J, Fink HA, KadoDM,Marshall LM. Back pain, neurogenic symptoms, and physical function in relation to spondylolisthesis among elderly men. Spine J. 2010;10:865–73. doi:10.1016/j.spinee.2010.07.004. • Docking RE, Lane M, Schofield PA. Developing an iPhone APP for the assessment of pain in older adults with dementia. Presented at the 7th International Congress of Pain in Dementia, Bergen, Norway, April 24–25, 2015.
  70. 70. • . Fang M, Noiseux N, Linson E, et al. The effect of advancing age on total joint replacement outcomes. Geriatr Orthop Surg Rehabil 2015;6(3):173–9. • Mok E, Woo CP. The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients. Complement Therap Nurs Midwifery 2004; 10: 209–16. • Kemp CA, Ersek M, Turner JA. A descriptive study of older adults with persistent pain: use and perceived effectiveness of pain management strategies. BMC Geriatr 2005; 5: 12.
  • EvinQasim

    Apr. 22, 2021

assessment and management of pain, physiotherapy pain management,

Vues

Nombre de vues

68

Sur Slideshare

0

À partir des intégrations

0

Nombre d'intégrations

0

Actions

Téléchargements

1

Partages

0

Commentaires

0

Mentions J'aime

1

×