Evidence-Based Practice Guideline : Acute Pain Management in Older Adults

Cornelius, Randy; Herr, Keela; Gordon, Debra B.; Kretzer, Kikikipa; Butcher, Howard K.

doi:10.3928/00989134-20170111-08

Cited by 10 publications

(8 citation statements)

References 67 publications

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“…Such prescribing practice has been found in other studies in which patients with hip fracture and dementia received lower rates of opioid analgesics postoperatively (Jensen-Dahm, Palm, Gasse, Dahl, & Waldemar, 2016). However, evidencebased guidelines for management of acute pain in older adults identify opioid analgesics as an important part of pain control for moderate to severe pain (Cornelius et al, 2017), particularly for treating nociceptive pain, which contributes substantially to central poststroke pain (Paolucci et al, 2016). Furthermore, systematic reviews and other evidence syntheses highlight the risk of total opioid avoidance in high-risk groups, as untreated pain is a strong risk factor for development of delirium and other negative outcomes, including depression, behavioral symptoms, and poorer physical functioning (Cheung et al, 2018;Clegg & Young, 2011;Erdal et al, 2017;Kolanowski et al, 2015;Miu & Chan, 2014;Won et al, 1999).…”

Section: Discussionmentioning

confidence: 65%

“…While very few studies have focused specifically on analgesic prescribing and pain management during transitions in care for patients with dementia, there is a growing body of literature on evidence-based pain management strategies that merit consideration. Notably, although acetaminophen is the recommended non-opioid agent for mild to moderate pain among older adults (Cornelius, Herr, Gordon, Kretzer, & Butcher, 2017), it was only prescribed to 66.5% of patients with a hip fracture and 42.2% of patients with stroke during hospitalization. Additionally, 15% of patients had acetaminophen discontinued upon discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Current pain management guidelines emphasize the importance of introducing one medication at a time and monitoring dose and drug changes, allowing sufficient time for efficacy and response to new drugs to be assessed (Cornelius et al, 2017). Arguably, changing analgesic agents immediately before transfer to a new facility, unfamiliar with patient's recent history, does not provide opportunity for these prescribing principles to be achieved.…”

Section: Discussionmentioning

confidence: 99%

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Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities

Gilmore‐Bykovskyi¹,

Block²,

Hovanes³

et al. 2019

Research in Gerontological Nursing

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Gaps in pain management, including discontinuity in analgesic medication prescribing, frequently complicate transitions from hospital-to-skilled nursing facilities (SNFs) for patients with dementia. The objective of the current study was to examine analgesic medication use and prescribing patterns in the last 48 hours of hospitalization and upon discharge to SNF among stroke and hip fracture patients with dementia. Of 318 patients that received an analgesic medication within the last 48 hours of hospitalization, 23% experienced potentially abrupt discontinuations upon discharge. These rates varied by medication, with acetaminophen with codeine (27%), hydromorphone (19%), and acetaminophen with hydrocodone (19%) having the highest rates of potentially abrupt discontinuations. Conversely, 38% of patients experienced potentially abrupt additions of an analgesic medication upon discharge. Findings suggest that changes to analgesic regimens prior to and upon discharge may be common practice, potentially hindering care continuity and pain control during transitions.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities

Gilmore‐Bykovskyi¹,

Block²,

Hovanes³

et al. 2019

Research in Gerontological Nursing

View full text Add to dashboard Cite

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“…[311][312][313][314][315][316][317][318] Existing CPGs concerning the use of acupuncture for pain are inconsistent and often differ regarding the evidence-based science and accepted mechanisms by which acupuncture has persisting effects on chronic pain. 54,[302][303][304][305][306][307]314,[319][320][321][322] As with all medicine, a risk-benefit analysis, consideration of clinical indications, and patient acceptance need to be considered.…”

Section: Complementary and Integrative Healthmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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“…Pain is common in older adults (>60 years of age) [85][86][87]. But treatment of their pain requires careful consideration of various factors, such as age-related physiologic changes, concomitant drug use and comorbidities (e.g., cardiovascular disease and cognitive impairment), which can potentially increase the risk of adverse drug reactions [88,89].…”

Section: Older Peoplementioning

confidence: 99%

Nonprescription Drugs Recommended in Guidelines for Common Pain Conditions

Hagen¹,

Alchin

2019

Pain Manag.

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Evidence-based pain guidelines allow recommendation of nonprescription analgesics to patients, facilitating self-care. We researched clinical practice guidelines for common conditions on websites of pain associations, societies, health institutions and organizations, PubMed, ProQuest, Embase, Google Scholar until April 2019. We wanted to determine whether there is a consensus between guidelines. From 114 identified guidelines, migraine (27) and osteoarthritis (26) have been published most around the world, while dysmenorrhea (14) is mainly discussed in developing countries. Specific recommendations to pregnant women, children and older people predominantly come from the UK and USA. We found that acetaminophen and oral nonsteroidal anti-inflammatory drugs (NSAIDs) represent first-line management across all pain conditions in adults and children. In osteoarthritis, topical NSAIDs should be considered before oral NSAIDs. This knowledge might persuade patients that using these drugs first could enable fast and effective pain relief.

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Evidence-Based Practice Guideline : Acute Pain Management in Older Adults

Cited by 10 publications

References 67 publications

Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities

Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Nonprescription Drugs Recommended in Guidelines for Common Pain Conditions

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