Chronic pain in older and senile patients. Clinical guidelines

Ткачева, О. Н.; Наумов, А. В.; Kotovskaya, Yu. V.; Рунихина, Н. К.; Мильто, А. С.; Alexanyan, L. A.; Ховасова, Н. О.; Мороз, В. И.; Маневич, Т. М.; Розанов, А. В.; Остапенко, В. С.; Мешков, А. Д.

doi:10.37586/2686-8636-3-2021-275-312

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Rossiiskii zhurnal geriatricheskoi meditsiny

2021

DOI: 10.37586/2686-8636-3-2021-275-312

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Chronic pain in older and senile patients. Clinical guidelines

О. Н. Ткачева

А. В. Наумов

Yu. V. Kotovskaya

et al.

Abstract: The present document developed by the Russian Association of Gerontologists and Geriatricians represents the Clinical guidelines on chronic pain in older and senile patients. The Clinical guidelines were endorsed by Scientific Council of the Ministry of Health of the Russian Federation in December 2020.Clinical guidelines are focused on geriatricians providing medical care in outpatient and hospital settings, general practitioners, and physiotherapists.The document sets out the pain syndrom screening and diagn… Show more

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Cited by 6 publications

References 270 publications

(126 reference statements)

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Evaluation of the impact of a course of therapy with an injectable form of chondroitin sulfate on the duration of remission and quality of life in patients with osteoarthritis

Kovalenko,

Dydykina,

Alekseeva

et al. 2023

Sovremennaâ revmatologiâ

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Ensuring a long-lasting effect of the therapy and its safety are important tasks in the treatment of patients with osteoarthritis (OA). Parenteral forms of chondroitin sulfate (CS) used for the background therapy of OA are characterized by proven efficacy and safety and, compared to oral forms, have greater bioavailability, faster onset of symptom-modifying effect and maintenance of more stable remission, which can significantly improve patients' quality of life.Objective: to evaluate the clinical efficacy and safety of two-month therapy with injectable CS and the duration of positive dynamics after the end of treatment in patients with knee OA (KOA).Material and methods. The open prospective observational study involved 35 patients (mainly women) aged 50–75 years with stage II–III KOA. All patients were prescribed intramuscular therapy with a CS solution (Mucosat® solution), with the first three injections of 1 ml, followed by 2 ml every second day (25 injections in total). Standard indices and questionnaires were used to assess the main clinical indicators at baseline and over time (14, 30, 60 days, 5 and 8 months after the start of treatment), as well as the results of ultrasound examination of the knee at baseline and at the end of treatment.Results and discussion. 14 days after the start of therapy, a statistically significant decrease in pain was observed applying the visual analogue scale (VAS), and after 2 months, 94% of patients had a significant decrease in knee pain according to VAS, Lequesne index and WOMAC index (total score and components). The KOOS parameters and quality of life according to EQ-5D-3L improved significantly. There was no pain or only minor pain (VAS ≤40 mm) in 54% of patients. The number of patients who had to take nonsteroidal anti-inflammatory drugs (NSAIDs) constantly fell threefold, while occasional use fell fivefold. The thickness of the synovial membrane of the knee joint and the number of patients with signs of synovitis decreased significantly. At 3 and 6 months after the end of therapy, most patients (60%) still had minor pain (≤40 mm according to VAS) and a significantly lower need for NSAIDs compared to baseline. The injectable CS was well tolerated and no adverse drug events were noted.Conclusion. We demonstrated both safety and efficacy and long-term maintenance of the clinical effect (6 months after the end of therapy) of injectable CS in the majority of OA patients, against the background of a low need for NSAIDs.

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Evaluation of the impact of a course of therapy with an injectable form of chondroitin sulfate on the duration of remission and quality of life in patients with osteoarthritis

Kovalenko,

Dydykina,

Alekseeva

et al. 2023

Sovremennaâ revmatologiâ

View full text Add to dashboard Cite

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Associations between cognitive status and geriatric syndromes in institutionalized oldest old

Исаев

Mkhitaryan

Strazhesko

et al. 2023

РНЖ

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Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. Disability and institutionalization in oldest old is associated with an increased risk of cognitive impairment. The relationship between cognitive status and other geriatric syndromes has not been studied sufficiently in institutionalized oldest old.Objective. To assess the relationship between cognitive status and geriatric syndromes in persons ≥ 90 years, who live in long term care facilities (LTCF).Material and methods. The study involved patients aged ≥ 90 years, who were examined in the LTCF of Moscow. All patients underwent a neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fluency. A comprehensive geriatric assessment was carried out for all the subjects. To diagnose the frailty, we used the Short Physical Performance Battery (SPPB). The Bartel index was used to assess performance of activities of daily living. Instrumental activities of daily living were assessed using the Lawton scale. Nutritional status was assessed based on the Mini-Nutritional Assessment. The pain intensity syndrome was assessed by visual analogue scale. To detect dinopenia we used dynamometry with manual dynamometer. Statistical data analysis was performed using the statistical program SPSS 23.0 (SPSS Inc., USA). Fischer’s two-sided accurate test was used for two groups comparison. The relationships between the variables were evaluated using binary logistic regression with calculation of the odds ratio (OR) and 95% confidence interval (CI).Results. Dementia was diagnosed in 69% of patients. According to multivariate analysis, sensory defi ciency (OR 4.23; CI 95% 1.96–9.09; p < 0.001), malnutrition (OR 2.68; CI 95% 1.10–6.52; p = 0.030), fecal incontinence (OR 4.37; CI 95% 2.14–8.90; p < 0.001), frailty (OR 4.23; CI 95%; 1.96–9.09; p < 0.001) are associated with the presence of dementia; an increase in age for every 1 year correlates with an increase in the chances of having dementia by 15%. Urinary incontinence and chronic pain syndrome were noted in more than half of oldest old, constipation syndrome and falls syndrome were detected in more than a third of the subjects, and more than 2/3 of oldest old had dinopenia.Conclusion. The majority of institutionalized oldest old suffer from dementia, while an increase in the chances of having it is associated with frailty, sensory deficiency, malnutrition and an increase in the age of oldest old.

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Managing Older and Oldest-Old with Frailty in Outpatient and Inpatient Clinics of Moscow (Treatment Algorithm Based on CGA Rresults)

Trukhanov,

Runikhina,

Reshetova

et al. 2023

Rossiiskii zhurnal geriatricheskoi meditsiny

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The article is aimed at improving the management of older and oldest-older in outpatient and inpatient medical facilities of Moscow. Represented algorithm of therapeutic and preventive measures allows the geriatrician, in accordance with CGA domains and possible clinical situations, to timely and efficiently draw up a patient management plan based on the results of CGA and current clinical guidelines.

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Chronic pain in older and senile patients. Clinical guidelines

Cited by 6 publications

References 270 publications

Evaluation of the impact of a course of therapy with an injectable form of chondroitin sulfate on the duration of remission and quality of life in patients with osteoarthritis

Evaluation of the impact of a course of therapy with an injectable form of chondroitin sulfate on the duration of remission and quality of life in patients with osteoarthritis

Associations between cognitive status and geriatric syndromes in institutionalized oldest old

Managing Older and Oldest-Old with Frailty in Outpatient and Inpatient Clinics of Moscow (Treatment Algorithm Based on CGA Rresults)

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