Abstract
Whereas postoperative pain was once thought to be an inevitable, albeit severely unpleasant, consequence of surgery, it is now clear that appropriate analgesic therapies can result in effective pain management for nearly all surgical patients. Nevertheless, despite recent efforts to improve management of pain in the United States, undertreatment of pain, particularly postoperative pain, remains a persistent problem.1,2 This undertreatment appears to be dramatically worse in the elderly.3 Untreated or undertreated pain may have a substantial impact on patients’ postoperative recovery and may exacerbate underlying co-morbidities and normal age-related physiologic changes. Pain can induce tachycardia, increase myocardial oxygen requirements, and produce cardiac ischemia. Pain, or the fear of pain, may lead to limited postoperative physical activity, which may further increase the risk of thromboembolism, urinary retention, fecal impaction, ileus, and atelectasis. For all these reasons, control of postoperative pain in the elderly surgical patient is of critical importance.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Lynch E, Lazor M, Gellis J, Orav J, Goldman L, Marcantonio E. Patient experience of pain after elective noncardiac surgery. Anesth Analg 1997;85:117–123.
Oates J, Snowdon S, Jayson D. Failure of pain relief after surgery. Anaesthesia 1994;49:775–758.
Ferrell B. Pain management in elderly people. J Am Geriatr Soc 1991;39:64–73.
World Health Organization (WHO). Cancer Pain Relief. Geneva: WHO, 1986.
Harkins S. Pain perceptions in the old. Clin Geriatr Med 1996;12:435–459.
IASP Subcommittee on Taxonomy Pain Terms. A list with definitions and notes on usage. Pain 1979;6:249.
Portenoy R, Foley K, Inturrisi C. The nature of opioid responsiveness and its implications for neuropathic pain: new hypotheses derived from studies of opioid infusions. Pain 1990;43:273–286.
Ferrell B, Ferrell B, Osterweil D. Pain in the nursing home. J Am Geriatr Soc 1990;38:409–414.
Roy R, Michael T. Survey of chronic pain in an elderly population. Can Fam Physician 1986;32:513.
Camp L. A comparison of nurses’ record assessment of pain with perceptions of pain as described by cancer patients. Cancer Nurs 1988;11:237–243.
Teske K, Daut R, Cleeland C. Relationships between nurses’ observations and patients’ self-reports of pain. Pain 1983;16:289–296.
Leventhal E, Prohaska T. Age, symptom interpretation and health behavior. J Am Geriatr Soc 1986;34:185–191.
Greenlee K. Pain and analgesia: considerations for the elderly in critical care. AACN Clin Issues Crit Care Nurs 1991;2:720–728.
Clinton P, Eland J. Pain. In: Maas M, Buckwalter K (eds) Nursing Diagnoses and Intervention for the Elderly. Reading, MA: Addison-Wesley, 1990:348–368.
Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975;1:277–299.
Melzack R. The short-form McGill Pain Questionnaire. Pain 1987;30:191–197.
Daut R, Cleeland C, Flanery R. The development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 1983;17:197–210.
Fishman B, Pasternak S, Wallenstein S, Houde R, Holland J, Foley K. The Memorial pain assessment card: a valid instrument for the evaluation of cancer pain. Cancer 1987;60:1151–1158.
Ferrell B, Ferrell B, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995; 10:591–598.
Sengstaken E, King S. The problem of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc 1993;41:541–544.
Parmelee P. Pain in cognitively impaired older persons. Clin Geriatr Med 1996;12:473–487.
Mateo O, Da K. A pilot study to assess the relationship between behavioral manifestations and self-report of pain in post-anesthesia care unit patients. J Post Anesth Nurs 1992;7:15–21.
Le Resche L, Dworkin S. Facial expressions of pain and emotions in chronic TMD patients. Pain 1988;35:71–78.
Ferreira S. Prostaglandins: peripheral and central analgesia. In: Bonica J, Lindblom U, Iggo A (eds) Advances in Pain Research and Therapy. New York: Raven Press, 1983.
Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline No. 9. AHCPR Publication No. 94–0592. Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service; 1994:257.
Etches RC, Warriner CB, Badner N, et al. Continuous intravenous administration of ketorolac reduces pain and morphine consumption after total hip or knee arthroplasty. Anesth Analg 1995;81:1175–1180.
Stouten E, Armbuster S, Houmes R, et al. Comparison of ketorolac and morphine for post operative pain after major surgery. Acta Anesthesiol Scand 1992;336:716–721.
Strom BL, Berlin JA, Kinman JL, et al. Parenteral ketorolac and risk of gastrointestinal and operative site bleeding: a postmarketing surveillance study. JAMA 1996;275:376–382.
Camu F, Lauwers MH, Vandersberghe C. Side effects of NSAIDs and dosing recommendations for ketorolac. Acta Anaesthesiol Belg 1996;47:143–149.
Maliekal J, Elboim CM. Gastrointestinal complications associated with intramuscular ketorolac tromethamine therapy in the elderly. Ann Pharmacother 1995;29:698–701.
Reynolds D. Surgery in the rat during electrical anaesthesia induced by focal brain stimulation. Science 1969;164: 444–445.
Akil H, Mayer D, Liebeskind J. Antagonism of stimulation-produced analgesia by naloxone, a narcotic antagonist. Science 1974;191:961–962.
Evans C, Hammond D, Frederickson R. The opioid peptides. In: Pasternak G (ed) The Opiate Receptors. Clifton Park, NJ: Humana Press, 1988:23–71.
Ling G, Spiegel K, Nishimura S, Pasternak G. Dissociation of morphine’s analgesic and respiratory depressant actions. Eur J Pharmacol 1983;86:487–488.
Ling G, Spiegel K, Nishimura S, Pasternak G. Separation of opioid analgesia from respiratory depresion: evidence for different receptor mechanisms. J Pharmacol Exp Ther 1985;232:149–155.
Heiman JS, Williams CL, Burks TF, Mosberg HI, Porreca F. Dissociation of opioid antinociception and central gastrointestinal propulsion in the mouse: studies with nalox-azine. J Pharmacol Exp Ther 1988:238.
Fishbain D, Rosomoff H, Rosomoff R. Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain 1992;8:77–85.
Beaver W, Wallenstein S, Rogers A, Houde W. Analgesic studies of codeine and oxycodone in patients with cancer. 1. Comparison of oral with intramuscular codeine and oral with intramuscular oxycodone. J Pharmacol Exp Ther 1978;207:92–100.
Beaver W, Wallenstein S, Rogers A, Houde R. Analgesic studies of codeine and oxycodone in patients with cancer. 2. Comparison of intramuscular oxycodone with intramuscular morphine and codeine. J Pharmcol Exp Ther 1978;207:101–108.
Kantor T, Hopper M, Laska E. Adverse effects of commonly ordered oral narcotics. J Clin Pharmacol 1981;21: 1–8.
Kalso E, Vanio A. Hallucinations during morphine but not during oxycodone treatment. Lancet 1987;2:912.
Chan G, Matzke G. Effects of renal insufficiency on the pharmacokinetics and pharmacodynamics of opioid analgesics. Drug Intell Clin Pharm 1987;21:773–783.
Sunshine A. New clinical experience with tramadol. Drugs 1994;47:8–18.
Moore R, McQuay H. Single-patient data meta-analysis of 3453 postoperative patients: oral tramadol versus placebo, codeine, and combination analgesics. Pain 1997;69:287–294.
Sawe J, Svensson J, Rane A. Morphine metabolism in cancer patients on increasing oral doses—no evidence of autoinduction or dose-dependence. Br J Clin Pharmacol 1983;16:85–93.
Pasternak G, Bodnare R, Clarke J, Inturrisi C. Morphine-6-glucuronide, a potent mu agonist. Life Sci 1987;41:2845–2849.
Portenoy R, Khan E, Layman M, et al. Chronic morphine therapy for cancer pain: plasma and cerebrospinal fluid morphine and morphine-6-glucuronide concentrations. Neurology 1991;41:1457–1461.
Houde R, Wallenstein S, Beaver W. Evaluation of analgesics in patients with cancer pain. In: Lasagna L (ed) International Encyclopedia of Pharmacology and Therapeutics. New York: Pergamon, 1966:59–67.
Twycross R. The use of narcotic analgesics in terminal illness. J Med Ethics 1975;1:10–17.
Labella F, Pinsky C, Havlicek V. Morphine derivatives with diminished opiate receptor potency show enhanced central excitatory activity. Brain Res 1979;174:263–271.
Morley J, Miles J, Wells J, Bowsher D. Paradoxical pain. Lancet 1992;340:1045.
Smith M, Watt J, Cramond T. Morphine-3-glucuronide: a potent antagonist of morphine analgesia. Life Sci 1990;47: 579–585.
Jaffe J, Martin W. Opioid analgesics and antagonists. In: Gillman A, Rail T, Nies A, Taylor P (eds) Goodman and Gilman’s The Pharmacological Basis of Therapeutics. New York: Pergamon, 1990:485–521.
Kaiko R. Controlled-release oral morphine for cancer-related pain: the European and North American experiences. Adv Pain Res Ther 1990;14:171–189.
Osborne R, Joel S, Slevin M. Morphine intoxication in renal failure: the role of morphine-6-glucuronide. BMJ 1986;292: 1548–1549.
Houde R. Clinical analgesic studies of hydromorphone. Adv Pain Res Ther 1986;8:129–135.
Babul N, Darke A, Hagen N. Hydromorphone metabolite accumulation in renal failure. J Pain Symptom Manage 1995;10:184–186.
Moulin D, Kreeft J, Murray-Parsons N, Bouquillon A. Comparison of continuous subcutaneous and intravenous hydromorphone infusions for management of cancer pain. Lancet 1991;337:465–468.
Fine P, Marcus M, Just De Boer A, Van der Oord B. An open label of oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough cancer pain. Pain 1991;45:149–153.
Pasternak G. Pharmacological mechanisms of opioid analgesia. Clin Neuropharmacol 1993;16:1–18.
Houde E, Wallenstein S, Beaver W. Clinical measurement of pain. In: Analgesics. San Diego: Academic, 1975:75–122.
Faisinger R, Schoeller T, Bruera E. Methadone in the management of chronic pain: a review. Pain 1993;52:137–147.
Beaver W, Wallenstein S, Houde R, Rogers A. A clinical comparison of the analgesic effects of methadone and morphine administered intramuscularly and of oral and par-enterally administered methadone. Clin Pharmacol Ther 1967;8:415–426.
Sawe J. High dose morphine and methadone in cancer patients: clinical pharmacokinetic consideration of oral treatment. Clin Pharmacol 1986;11:87–106.
Morley J, Watt J, Wells J, Miles J, Finnegan M, Leng J. Methadone in pain uncontrolled by morphine. Lancet 1993;342:1243.
Kreek M, Schecter A, Gutjahr C, Hecht M. Methadone use in patients with chronic renal disease. Drug Alchohol Depend 1980;5:195–205.
Szeto H, Inturrisi C, Houde R, et al. Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure and cancer. Ann Intern Med 1977;86:738–740.
Kaiko R, Foley K, Grabinski P, et al. Central nervous system excitatory effects of meperidine in cancer patients. Ann Neurol 1983;13:180–185.
Macintyre P, Jarvis D. Age is the best predictor of postoperative morphine requirements. Pain 1995;64:357–364.
Egbert A, Parks L, Short L, Burnett M. Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men. Arch Intern Med 1990;150:1897–1903.
Stjernsward J, Teoh N. Current status of the Global Cancer Control Program of the World Health Organization. Pain Symptom Manage 1993;8:340–347.
Yeager M, Glass D, Neff R, Brinck-Johnsen T. Epidural anesthesia and analgesia in high risk surgical patients. Anesthesiology 1987;66:729–736.
World Health Organization. Cancer Pain Relief and Palliative Care. Geneva: WHO, 1990.
Foley KM. The treatment of cancer pain. N Engl J Med 1985;313:84–95.
Woolf C. Evidence for a central component of post-injury hypersensitivity. Nature 1983;306:686–688.
McQuay H. Pre-emptive analgesia: a systematic review of clinical studies. Ann Med 1995;27:249–256.
Quinn A, Brown J, Wallace P, Asbury A. Studies in postoperative sequelae: nausea and vomiting—still a problem. Anaesthesia 1993;49:62–65.
Yang K, Portenoy R. Pain management in the geriatric surgical patient. In: Katlic M (ed) Geriatric Surgery. Baltimore: Urban & Schwarzenberg, 1990:329–348.
Knill R, Clement J, Thompson W. Epidural morphine causes delayed and prolonged respiratory depression. Can Anaesth Soc J 1981;28:537.
Kanner R, Foley K. Patterns of narcotic use in a cancer pain clinic. Ann NY Acad Sci 1981;362:161–172.
Brescia F, Portenoy R, Ryan M, Krasnoff L, Gray G. Pain, opioid use, and survival in hospitalized patients with advanced cancer. J Clin Oncol 1992;10:149–155.
Weissman D, Haddox J. Opioid pseudoaddiction: an iatrogenic syndrome. Pain 1989;36:363–366.
Melzack R, Wall P. Pain mechanism: a new theory. Science 1965;150:971–979.
Hymes A, Yonegiro E, Raab D, Nelson G, Printy A. Electrical stimulation for the treatment and prevention of ileus and atelectasis. Surg Forum 1974;25:222–224.
Richardson R, Cerullo L. Transabdominal neurostimulation in the treatment of neurogenic ileus. Allp Neuro-physiol 1979;42:375–382.
Coan R, Wong G, Coan P. The acupuncture treatment of low back pain: a randomized controlled trial. Am J Chin Med 1980;8:181–189.
Coan R, Wong G, Coan P. The acupuncture treatment of neck pain: a randomized controlled study. Am J Chin Med 1980;9:362–332.
Vincent C. A controlled trial of the treatment of migraine by acupuncture. Clin J Pain 1990;1989:305–312.
Helms J. Acupuncture for the management of primary dysmenorrhea. Obstet Gynecol 1987;69:51–56.
Christensen P, Noreng M, Andersen P, Nielsen J. Elec-troacupuncture and postoperative pain. Br J Anaesth 1989; 62:258–262.
Haanen H, Hoenderdos H, van Romunde L, et al. Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia. J Rheumatol 1991;18:72–75.
Spiegel D, Bloom J. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 1982;45: 333–339.
Syrjala K, Cummings C, Donaldson G. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial. Pain 1992;48:137–146.
Zeltzer L, LeBaron S. Hypnosis and non-hypnotic techniques for reduction of pain and anxiety in children and adolescents with cancer. Behav Pediatr 1982;101:1032–1035.
Brown D. Transurethral resection under self-hypnosis. Am J Clin Hypn 1973;16:132–134.
Lawlis G, Selby D, Hinnant D, McCoy C. Reduction of postoperative pain parameters by presurgical relaxation instructions for spinal pain patients. Spine 1985;10:649–651.
Ceccio C. Postoperative pain relief through relaxation in elderly patients with fractured hips. Orthop Nurs 1984;3:11–19.
Flaherty C, Fitzpatrick J. Relaxation technique to increase comfort level of postoperative patients: a preliminary study. Nurs Res 1978;27:352–355.
Langer E, Janis I, Wolfer J. Reduction in psychological stress in surgical patients. J Exp Soc Psychol 1975;11:155–165.
Weis O, Sriwatanakul K, Weintraub M, Lasagna L. Reduction of anxiety and postoperative analgesic requirements by audiovisual instruction. Lancet 1983;1:43–44.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer Science+Business Media New York
About this chapter
Cite this chapter
Morrison, R.S., Carney, M.T., Manfredi, P.L. (2001). Pain Management. In: Rosenthal, R.A., Zenilman, M.E., Katlic, M.R. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3432-4_12
Download citation
DOI: https://doi.org/10.1007/978-1-4757-3432-4_12
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4757-3434-8
Online ISBN: 978-1-4757-3432-4
eBook Packages: Springer Book Archive