Evidence-based clinical practice guidelines on management of pain in older people

Abdulla, Aza; Bone, Margaret; Adams, Nicola; Elliott, Alison M; Jones, Derek; Knaggs, Roger; Martin, DJ; Sampson, Elizabeth L; Schofield, Patricia

doi:10.1093/ageing/afs199

Cited by 262 publications

(176 citation statements)

References 28 publications

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“…Pain is also known to lead to limitation of physical activity and to a cycle of restriction, decreased participation, and greater disabilities, and it often overlaps with symptoms of depression (Molton and Terrill 2014). Although the location of pain was not registered in this thesis the most common sites of pain in older people are known to be located in the back, neck, leg/knee or hip and other joints (Abdulla et al 2013). Previous studies have reported that pain is often underdiagnosed and undertreated in older people with multimorbidity (Abdulla et al 2013, Kaye et al 2014, Landi et al 2001.…”

Section: Msas Subscale Scoresmentioning

confidence: 88%

“…Although the location of pain was not registered in this thesis the most common sites of pain in older people are known to be located in the back, neck, leg/knee or hip and other joints (Abdulla et al 2013). Previous studies have reported that pain is often underdiagnosed and undertreated in older people with multimorbidity (Abdulla et al 2013, Kaye et al 2014, Landi et al 2001. Sometimes older people do not discuss or mention pain when consulting their health care provider, thinking that pain is a natural part of aging (Kaye et al 2014).…”

Section: Msas Subscale Scoresmentioning

confidence: 93%

“…However, new guidance for treating pain in the elderly was published in 2013 (Abdulla et al 2013). To manage pain, a comprehensive assessment is recommended involving a multidisciplinary approach with the appropriate use of various treatment alternatives with both pharmacotherapy, and interventional procedures such as physical rehabilitation, and psychological support (Kaye et al 2014, Abdulla et al 2013). …”

Section: Msas Subscale Scoresmentioning

confidence: 99%

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Symptom burden among people with chronic disease

Eckerblad¹

2015

Linköping University Medical Dissertations

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Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief. Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease. Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT. Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III). Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider

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Section: Msas Subscale Scoresmentioning

confidence: 88%

Section: Msas Subscale Scoresmentioning

confidence: 93%

Section: Msas Subscale Scoresmentioning

confidence: 99%

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Symptom burden among people with chronic disease

Eckerblad¹

2015

Linköping University Medical Dissertations

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“…Then, in 2015, the National Institute for Health and Care Excellence (NICE) published a dementia pathway that emphasised the importance of recognising and treating pain. 15 In addition, two sets of national guidance have been published, one for assessing 16 and another for managing 17 the pain of older people, each of which considers issues related to cognitive impairment in this group. Although these are useful additions to the information available for clinicians, we do not yet know how to assess and manage the pain of people with cognitive impairment effectively, particularly in acute settings.…”

Section: -13mentioning

confidence: 99%

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

Closs

Dowding

Allcock³

et al. 2016

Health Serv Deliv Res

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 11/2000/05. The contractual start date was in October 2012. The final report began editorial review in October 2015 and was accepted for publication in March 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Heal...

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“…There is an increasing emphasis on the timely identification and management of pain among people with dementia, with prevalence estimates ranging between 50 and 93% [1][2][3]. Alzheimer's disease (AD) is the most common form of dementia, accounting for approximately 60% of cases [4].…”

Section: Introductionmentioning

confidence: 99%

Is pain sensitivity altered in people with Alzheimer's disease? A systematic review and meta-analysis of experimental pain research

Stubbs

Thompson

Solmi

et al. 2016

Experimental Gerontology

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Clinical studies suggest people with Alzheimer's disease (AD) have altered pain sensitivity. Experimental pain research is equivocal.\ud Conduct a meta-analysis to investigate if people with AD have altered pain sensitivity compared to healthy controls (HCs).\ud Three authors searched electronic databases from inception till November 2015 for experimental pain studies in AD vs. HCs. Outcome measures were pain threshold, tolerance, pain ratings, heart rate response to noxious stimuli and the Facial Action Coding System (FACS). Random effect meta-analysis calculating Hedges' g±95% confidence intervals (CI) was conducted.\ud Thirteen studies were identified, including 256 people with AD (74.6 (±5.6) years, 59% females with a mean mini mental state examination (MMSE) score of 19.2) and 260 HCs. Meta-analysis demonstrated no significant difference in pain threshold (g=0.025, 95% CI -0.315-0.363, p=0.88, n AD=135, n HCs=157), pain tolerance (g=-0.363, 95% CI -2.035-1.309, p=0.67, n AD=41, n HCs=53) or pain intensity ratings (g=0.03, p=0.89, n AD=138, n HCs=135). Heart rate response to pain was less pronounced in AD but not significant (g=-0.746, p=0.11). People with AD (n=90) had significantly higher FACS scores versus HCs (n=109) (g=0.442, p=0.03) indicating increased pain. Meta-regression demonstrated that an increasing percentage of AD female participants moderated pain threshold (p=0.02) whilst MMSE scores did not (p=0.19).\ud People with AD have a greater sensitivity to pain when validated observer ratings of facial expressions are used. Verbal response to painful stimuli, even under experimental conditions, may mean pain is not identified in people with AD. Clinically useful observer rated pain tools may be the most appropriate way to assess pain in AD

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Evidence-based clinical practice guidelines on management of pain in older people

Cited by 262 publications

References 28 publications

Symptom burden among people with chronic disease

Symptom burden among people with chronic disease

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

Is pain sensitivity altered in people with Alzheimer's disease? A systematic review and meta-analysis of experimental pain research

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