Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). INSTRUCTIONS: Respond to two of your peers, and discuss two separate resources they did not mention
POST # 2 DOUGLAS
Pain Assessment and Treatment
The United States is facing an ever-increasing elderly population and with that will come the challenges of treating their unique diseases and illnesses. One of the most frequent complaints of elderly patients in the primary and emergency room settings is that of chronic pain. Chronic pain has been defined as any pain that lasts for more than six months. In the elderly the physiology behind the pain is often different than in younger patients (Paul-Savoie, 2018).
The opioid epidemic which faces the United States has been higher in patients over the age of sixty than for those under sixty. In fact, there is almost double the number of serious reported medical issues of a serious nature reported amongst the elderly related to opioids (Choi,2019).
Managing pain in the elderly can be difficult as many elderly patients do not want to inconvenience anyone with their pain issues and some, especially those with dementia, often under report their pain. It is up to the care givers and providers to identify the physical signs and symptoms so that proper diagnoses and treatment can occur (Webster, 2019).
It must be understood that there are many components to pain that must be address in the treatment plan including possible physical causes as well as underlying psychological and psychosocial factors that may be affecting the patient and their adherence to the care plan. (Quinlan-Colwell,2012).
Changes that occur as we age bring about different root causes of pain, how the patient will process and or tolerate that pain and how they may process the medicine that we are prescribing. Essential neurotransmitters such as serotonin, acetylcholine, noradrenaline and gamma-aminobutyric acid (GABA) are less abundant in the elderly and since they are major components involved in the intake of pain medicine the efficacy may be different therefore dosing may need to be changed. There is also a decrease in peripheral nociceptive neurons int eh elderly patient. Pain thresholds are often exacerbated by depression and anxiety that are untreated in the elderly patients as well (Quinlan-Colwell,2012).
One such tool that was used in the above studies is the Mobility Roland–Morris disability questionnaire (RDQ). This study includes twenty-four yes or no questions pertaining to activities of daily living. This toll is primarily designed to be used in the primary care setting and assesses social wellbeing, overall function and support. It is widely used and recommended for the assessment of chronic pain and has been translated into over thirty different languages for use around the world. Many studies have proven the reliability and validity of this assessment tool ( Yamato,2017).
National institute of health reported that Nevada providers prescribed opioids at a higher rate than other states, approximately four more prescriptions per hundred persons just over eleven percent of deaths by overdose involved opioids and almost nine percent of those were prescribed. Those numbers have been on a decline over the past few years. For the elderly in Nevada the Seven Hills Mental health hospital, just outside of Las Vegas has great programs for recovery. Their programs are designed to assess underlying causes of the addiction and to assist with life changes needed to fight addiction.
Resources:
https://www.help.org/drug-and-alcohol-rehab-centers-in-nevada/
http://dpbh.nv.gov/Resources/opioids/Prescription_Drug_Abuse_Prevention/
https://www.nvopioidresponse.org/general-resources/
References
Choi, B. Y., DiNitto, D. M., Marti, C. N., & Choi, N. G. (2019). Emergency Department Visits and Overnight Hospital Stays among Persons Aged 50 and Older Who Use and Misuse Opioids. Journal of Psychoactive Drugs, 51(1), 37–47. https://doi.org/10.1080/02791072.2018.1557356
Paul-Savoie, E., Bourgault, P., Potvin, S., Gosselin, E., & Lafrenaye, S. (2018). The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management. Pain Research & Management, 2018, 6375713. https://doi.org/10.1155/2018/6375713
Quinlan-Colwell, A. (2012). Compact Clinical Guide to Geriatric Pain Management : An Evidence-Based Approach for Nurses. New York: Springer Publishing Company. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=440783&site=eds-live
Webster, F., Rice, K., Katz, J., Bhattacharyya, O., Dale, C., & Upshur, R. (2019). An ethnography of chronic pain management in primary care: The social organization of physicians’ work in the midst of the opioid crisis. PLoS ONE, 14(5), 1–16. https://doi.org/10.1371/journal.pone.0215148
Yamato, T. P., Maher, C. G., Saragiotto, B. T., Catley, M. J., & McAuley, J. H. (2017). The Roland-Morris Disability Questionnaire: one or more dimensions? European Spine Journal: Official Publication Of The European Spine Society, The European Spinal Deformity Society, And The European Section Of The Cervical Spine Research Society, 26(2), 301–308. https://doi.org/10.1007/s00586-016-4890-9
https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/nevada-opioid-involved-deaths-related-harms
