Pain management in the older adult can be a challenge due to the risk of adverse effects of opioids and other pain medications. In the discussion this week, share an experience from clinical of a patient with pain that you had difficulty managing. Describe this patient including age, gender, comorbid conditions, and type of pain. How was the pain being managed? What changes did you implement? Review the CDC guidelines and other readings and indicate if you think your plan is consistent with the guidelines or if you should change your plan based on these resources. Need 3 references.
When considering older adults with pain, almost 50% have persistent pain and almost 65% of nursing home or community-dwelling residents report having inadequately or undertreated pain (Epplin, Higuchi, Gajendra & Nadella, 2014). However, there are many factors related to pain including it is subjective and patient specific. Therefore, pain management can be challenging for health care providers. The impact of pain or persistent pain can greatly affect one’s quality of life. For some people, persistent pain can contribute to disability, financial hardships, despair, frailty, and increases chances of early mortality as well (Arnstein & Herr, 2017). In my clinical, I visited a 74-year-old female with chronic and persistent pain along with CHF, essential hypertension, hyperlipidemia, diabetes mellitus, osteoarthritis, peripheral neuropathy, and depression. This patient’s pain is derived from a previous back surgery, bilateral knee replacements, osteoarthritis, and peripheral neuropathy. Currently her pain was unmanaged on Tramadol 50mg BID, Gabapentin 100mg TID, and topical capsaicin cream. For this patient, we performed a comprehensive medication review, pain assessment and a cognitive assessment prior to making any changes to the current medication regimen. The patient reports more pain at night which is interrupting her sleep, no side effects to current medications, and no cognitive impairment upon assessment. I recommended increasing the patient’s dose of Gabapentin and possibly adding Duloxetine to her treatment plan. My reasoning for adding Duloxetine, some adjuvant analgesic agents or neuromodulators, such as Gabapentin or duloxetine, can help target pain amplifiers and reduce neuropathic pain (Davies, 2017). Since the patient was not experiencing any side effects or adverse drug reactions with her current medication regimen then I think it is safe to increase her Gabapentin to 200mg TID and add Cymbalta 30mg Qday. Of course, we will monitor the patient to make sure she is tolerating the new medication. Finally, I think it’s important to always assess pain with all our patients to ensure wellness and a better quality of life.