Sourcebook : 3.1 Preventing, assessing, and treating pain

The American Geriatrics Society has developed a statement of principles about the domains to measure for quality in end-of-life care. Key recommendations include:

1. Pain should be an important part of each assessment of older patients; along with efforts to alleviate the underlying cause, pain itself should be aggressively treated.
2. Pain and its response to treatment should be objectively measured, preferably using a validated pain scale.
3. Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution. In older patients, NSAIDs have significant side effects and are the most common cause of adverse drug reactions. (The new Cox-2 agents may have a better side effect profile)
4. Acetaminophen is the drug of choice for relieving mild to moderate musculoskeletal pain.
5. Opioid analgesic drugs are effective for relieving moderate to severe pain.
6. Non-opioid analgesic medications may be appropriate for some patients with neuropathic pain and other chronic pain syndromes.
7. Nonpharmacologic approaches (e.g., patient and caregiver education, cognitive-behavioral therapy, exercise, etc.), used alone or in combination with appropriate pharmacologic strategies, should be an integral part of care plans for most chronic pain patients.
8. Referral to a multidisciplinary pain management center should be considered when pain management efforts do not meet the patient's or the health care provider's goals.
9. Regulatory agencies should review existing policies to enhance access to effective opioid analgesic drugs for older patients in pain.
10. Pain management education should be improved at all levels for all healthcare professionals.

Source: American Geriatrics Society, 1998.

This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.