Module 2: Direct Comprehensive Primary Care in the LTC Setting
Module 2: Direct Comprehensive Primary Care in the LTC Setting
52 2.5.10 Pain Management
Nociceptive Pain
- Somatic
- Caused by damage to soft tissue and bone
- Visceral (two types)
- Organ pain, caused by damage to organs, stretch of capsule
- Colic, caused by obstruction of viscera
- Neuropathic
- Peripheral
- Central, caused by injury to the CNS[1]
The World Health Organization or WHO Analgesic Ladder is the guide for pain management
First Step:
- Mild Pain
- Non-Opioid
Second Step:
- Moderate Pain
- Weak Opioid
Third Step:
Recommended Reading
Adjuvant Treatment
Consider the cause of the pain
Neuropathic Pain
- Opioids are less effective for neuropathic pain.
- Consider:
- Pregabalin – less associated sedation, needs to be renally dosed.
- Gabapentin – can be sedating, needs to be renally dose, has finer titration abilities given high ceiling dose.
- Duloxetine has some evidence for diabetic peripheral neuropathy in the geriatric patient.
Nociceptive Pain
- May be a role for NSAIDs, but approach with caution and short duration only
- Botox for spasticity
- Cannabinoids-increased risk for cognitive impacts, cautious dosing[7][8][9][10][11][12]
Geriatric Considerations
- Don’t forget non-pharmacological interventions!
- START LOW, GO SLOW
- Consider: Does the medication need renal dosing?
- Monitor for constipation
- Avoid NSAIDs, if absolutely required, use short duration and ensure adequate hydration
- Ensure you are targeting the treatment to the type of pain present
- Consult and review with pharmacist
- Pallium Canada, 2018 ↵
- WHO Analgesic Ladder, Anker et al., 2023 ↵
- Registered Nurses’ Association of Ontario, 2007 ↵
- Zacharias et al., 2013 ↵
- RxFiles, n.d. ↵
- Busse, 2017 ↵
- WHO Analgesic Ladder ↵
- Anker et al., 2023 ↵
- Registered Nurses’ Association of Ontario, 2007 ↵
- Zacharias et al., 2013 ↵
- RxFiles, n.d. ↵
- Busse, 2017 ↵