Elderly patient pain management

Bemabei, R., et al., "Management of Pain in Elderly Patients with Cancer," JAMA, 279, 1877-1882 (1998). 

There have been several reports of impaired renal function in patients taking ketorolac (SEDA-17, 112) (SEDA-18, 105) (SEDA-22, 117). The severity varies from slight to severe forms of renal insufficiency, which may even occur after a single dose of 30 mg. Because recent major surgery is considered a risk factor for renal insufficiency, particularly in elderly patients, the use of ketorolac, or other NSAIDs, for postoperative pain management is warranted only in carefully selected patients. Furthermore, a case report confirmed that oral ketorolac can cause acute renal insufficiency in young subjects without any predisposing factors (SEDA-21,106). 

Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. JAMA 1998 279 1877—1882. 

OxyContin is a controlled-released form of oxycodone and indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time OxyContin is not intended for use as a PRN analgesic The patient may experience fewer adverse reactions with oxycodone tlian morphine, and the drug is effective and safe for the elderly. The tablets are to be swallowed whole and are not to be broken, chewed, or crushed. 

This is another area primed for active pharmacy involvement as many of these patients are in nursing homes. These patients are usually undergoing monthly medication reviews by pharmacists who can suggest appropriate dosages and combinations for the management of pain. An article by Shimp estimated that 45-80% of nursing home residents and 20-50% of elderly in the community suffer from pain. This article discusses appropriate selection of therapy and the risks for adverse effects. 

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