Anshul Jain, Dr. Sarita Sachdeva H.O.D Department of Biotechnology., Faculty of Engineering and Technology, Faridabad and Dr.

S.K Jain Chief Pharmacist, AIIMS, New Delhi

GERIATRIC PAIN MANAGEMENT- An Experience

M E T H O D S

INTRODUCTION
Pain is the most common complaint of the elderly. Elderly persons than 65 years may have arthritis, joint disorders,cancer and other chronic disorders and may be associated with pain. Elderly are usually untreated or under-treated for pain. This is because of proper assessment of pain, underreporting by patients considering it their old age or out of their fear for treatments, atypical manifestations of pain, misconceptions about tolerance or may be due to excessive use of medicines or addiction to opioids etc. Thus they do not get the proper treatment and this puts a great impact on their quality of life resulting into depression,anxiety,sleep disorders,social isolation etc. The major barrier to the effective pain management in geriatrics is the proper assessment of pain. Since there are no biological markers, self-reporting is the best and most optimal way to assess pain intensity. Pain can be assessed using simple questions and screening tools. Main characteristics to be focused on are intensity, frequency and location. Function,gait,affect and cognition are the most standardized geriatric assessment tools. Intensity can be assessed by using any of the pain scales accepted for use in elderly, on which 0 means no pain and 10 means unbearable pain. Treatment should be initiated only after assessing the pain properly. Elderly are likely to show adverse effects of the drugs thus their pain should be managed with a combination of both nonpharmacological and pharmacological approaches. Elders should perform light physical exercises like jogging, balancing, aerobics etc. This would increase muscles' strength and flexibility. Other nonpharmacological approaches include acupuncture, acupressure, geriatric massage therapies etc. Whilst alleviating pain, these methods even delays or prevents several other disorders. However when the pain is unbearable, patients are given mild to moderate dosages of drugs like Aspirin, Paracetamol etc. The dosages should be kept to minimum and a careful record of each dosage and its effect should be maintained, if required to be recommended for future use.

CASE STUDIES
Mrs. X(name is omitted), a 70 year old woman, is facing various joint pains and back pain. She cannot do her work anymore and feels more depressed and agitated. She had been treated with opioid analgesics initially but this did not improve the pain. Now, she is given mild dosages of Aspirin and as soon as the pain is ceased, she started to carry out aerobics and goes for acupressure sessions in a clinic and her record is maintained so that occassional alterations could be made as and when needed. Now, she doesn't complain about pains anymore and is living a quality life again.

PHYSICAL EXERCISES Exercises consists of 3 components: Aerobic exercise, strength training, and balance and flexibility. It is important to motivate elders to begin exercises which is best achieved by focusing on individual patient goals, concerns, and barriers to exercise. To increase long-term compliance, the exercise prescription should be straightforward, fun, and geared toward a patient's individual health needs, beliefs, and goals.

ACUPRESSURE Thumbs are most commonly used to apply pressure. The degree of pressure applied varies, as does the duration. Moderate to penetrating pressure is employed for several seconds to several minutes, and the treatment can be performed once or repeatedly.

DISCUSSION
Elders do not generally complain about the pain for various reasons. Thus to prevent addition of various other symptoms it is necessary to start the treatment as early as possible to achieve the most favorable results, it is important to have a greater understanding of clinical manifestations of pain, improved methods of assessment and use of both pharmacological and nonpharmacological interventions for the treatment of pain, as and when required.

ACUPUNCTURE It is based on the belief of releasing blocked energy in living beings. These energy lines circulate through twelve invisible energy lines known as meridians of the body. Each meridian is associated with a different organ system so the needle insertions in each of these meridians reduce the respective disease associated with that meridian point

GERIATRIC MASSAGE THERAPIES Includes movements such as rubbing, tapping, rolling, pressing, kneading and feather touch. Massages can be targeted towards the area where disability or pain exists. The main purpose is to relax each and every part of the body.

KEY MESSAGE
From my observations I have seen that geriatric pain is easily managed with a proper plan of non-pharmacological therapies. Non-pharmacological therapies have many benefits over pharmacological methods. They yield more positive results, there is almost no risk of adverse effects, also they are very cost effective. Thus, it can be an innovation that WHEN GERIATRIC PAIN CAN BE MANAGED WELL WITH NON-PHARMACOLOGICAL METHODS, THEN WHY TO GO FOR MEDICATIONS.

MEDICATION THERAPIES Elders are likely to show adverse effects of the drugs. Thus extreme care and caution is needed. Treatment should be started with lower than adult doses. Painkillers like Paracetamol, Aspirin etc. are usually given. A careful observation, on medication monitoring and a record is required to be maintained of each dosage.