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New guidelines on pain control in older people

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Pain management in older people is often insufficient or inappropriate to their needs, it is claimed.

The British Pain Society and the British Geriatrics Society is launching a new guideline on the management of pain in older people after they carried out an extensive systematic review of the available literature.

It is the first UK guideline on the management of pain in older people and it aims to help healthcare professionals in all care settings to consider the options available to them.

The guideline is separated into sections addressing pharmacology, interventional therapies, psychological interventions, physical activity and assistive devices and complementary therapies.

It notes that the three most common sites of pain in older people are the back; leg/knee or hip; and “other” joints. It highlights that “stoicism is particularly evident within this cohort of people”.

Paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that of musculoskeletal origin, the guidance said.

Non-selective non-steroidal anti-inflammatory drugs should be used with caution in older people after other safer treatments have not provided sufficient relief, it said. The lowest dose should be provided, for the shortest duration.

Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing quality of life.

Professor Pat Schofield, chair of the working group that produced the guideline, said healthcare professionals often do not know what the best options are for managing pain in older people and treatment is rarely tailored to the individual’s needs.

Another problem, according to the professor, is that older people often do not report pain.

“National guidance on the management of pain in older people is long overdue and these evidence-based clinical guidelines are an important step towards improving quality of life for older people by focusing attention on a range of appropriate pain relief options and interventions,” Professor Schofield added.


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