Sep 26, 2016
Learn to treat non cancer pain
in the elderly. Managing persistent pain in the elderly can
be...painful. On this episode Matt and Paul interview Dr. Marissa
Galicia-Castillo, a Professor of Geriatrics from Eastern Virginia
Medical School board certified in Internal Medicine, Geriatrics,
Hospice/Palliative Medicine. Are we being too stingy with opioid
prescriptions? How do you assess and treat pain in patients with
advanced dementia? We’ve got your answers.
- Persistent pain in the elderly
is underrecognized and undertreated
- Nonpharmacologic therapy is
still first line (get off the couch!)
- Scheduled acetaminophen is a
valid first line
- Consider low dose oxycodone IR
as a second line (assuming NSAIDS contraindicated)
- Diversion of medication by
family members is a concern and may cause treatment
- Opiates can be a great tool.
Don’t be afraid to use them with careful patient
- Follow quality of life and
functional status as your end points for pain control.
- Pain in cognitively impaired
may present as behavior problems. Treat the pain and treat the
Dr. Galicia-Castillo reports no
relevant financial disclosures.
By the end of this podcast
listeners will be able to:
- Recognize that pain in the
elderly is often underrecognized and undertreated.
- Recognize the signs and
symptoms of pain in patients with cognitive impairment.
- Utilize opiates safely and
effectively for the management of noncancer pain in the
- Formulate a basic therapeutic
approach to noncancer pain utilizing nonpharmacologic and
Links from the show:
- Dr. Galicia-Castillo’s article
on use of opioids for persistent noncancer pain in older
- CDC guidelines on prescribing
opioids for chronic pain (#8 discusses criteria for naloxone
- World Health Organization Pain
- Observational study of Naloxone
administration along with opiate prescriptions (NEJM Journal Watch
- Effect size seen with opiates
and tramadol were small in this review, but adverse event rates
were high. This is why a trial with monitoring of functional status is
- A RCT looking at Tramadol for
knee osteoarthritis with underwhelming results.
- EULAR 2016 guidelines for
treatment of fibromyalgia
- Dr. Clauw’s YouTube
Chronic Pain: Is it all in their
- Dr. Clauw’s University of
Michigan website for patient self education on