Chronic Pain Management in Elderly and Drug Users in Acute Care Setting

Chronic Pain Management in Elderly and Drug Users in Acute Care Setting

Chronic pain is explained as a persistent episode of pain that continues beyond recovery and adversely affects the optimal well-being of the person. Often lasting for more than six months, chronic pain is associated with a wide range of health problems such as fatigue, mood changes, decreased appetite, and sleep disturbances (Abdulla, Adams, Bone, Elliott, Gaffin, Jones, Knaggs, British Geriatric Society, 2013). Unlike the acute pain whose onset is rapid but subsides after a short period, chronic pain develops insidiously and persists for months or even longer. The pain can be attributed to an initial injury such as a sprain or strain or originate from an ongoing cause for instance illnesses such as cancer.

Old age is characterized by a wide range of chronic diseases which are accompanied by pain that may last for a lifetime.  The treatment of chronic pain ranges from pharmacological and non-pharmacological methods. This journal reviews various studies and articles on the multiple modalities of controlling chronic pain. The therapy aims to block the nerve pain transmission or to distract the patient from the pain. These can be achieved by use of analgesics as well as engaging the patient in various distractive activities.

New Practice Approaches

In case of occurrence of chronic pain, treatment is often directed towards reduction of pain as well as improving the function of the affected area or the person himself or herself. Various therapies and medications together with other pain management techniques such as relaxation exercises, multiple treatments, and medicines along with different pain management techniques such as relaxation exercises and pacing can be of great significant in reducing chronic pain and improving the quality of life. Drugs used in minimizing the effects of chronic pain include acetaminophen and cyclooxygenase inhibitors. The non-analgesic medicines that were not used initially in managing chronic pain are clonidine, baclofen, certain antidepressants, and anticonvulsants. Promising drugs to manage chronic pain are ketamine, dextromethorphan, amantadine, and methadone. A combination of morphine sulfate and dextromethorphan are primarily used in relieving pain associated with cancer.


Pain management approaches can be complicated for the expertise of just one profession to handle. According to Abdulla et al. (2013), the delivery of these services requires the competency of different specialties in for the benefit of older patients who are suffering from chronic pain episodes. As such, the development of collaborative skills is an integral aspect of pain management. The teams of professionals that can be involved in the management of chronic pain in acute care settings are headed by a physician (Lewis, 2017). The doctor must work in collaboration with nurses, psychologists, physiotherapists, rheumatologists, and pharmacists. Collaboration demands that each expert recognizes and respect the unique roles of others that may be different to theirs.

Ethical Considerations

The ethical principles of autonomy, nonmaleficence, beneficence, and justice are applicable in pain management. Patients should always get the best care from the team of health professionals (Lewis, 2017). Most nurses apply the ethical principles of beneficence which implies doing good for an individual as well as refraining from harming (nonmaleficence). Adults with chronic pain syndrome are always confused and not in a position to make informed decisions. It is the role of the nurse to determine the best care that will alleviate or eradicate unpleasant, painful feeling.


The Role of Technology in Improving Healthcare Outcomes

Old age has been associated with a decrease in the perception of acute visceral pain. The burden of unrelieved pain experienced by the older people can be relieved when technology is involved in the care. The recently developed technological pain management strategies that have been accepted in managing pain include a combination of heat with transcutaneous electrical nerve stimulation (TENS), radiofrequency ablation devices and actipatch that make use of electromagnetic fields to modulate efferent nerve activity (Hansen, 2005). Others include spinal cord stimulation also referred to as burstDR stimulation as well as virtual reality.

Health Policy

The Center for Disease Control recognize that the prolonged use of opioids poses significant health risks among individuals, thus hampering their efficacy and preventing their use by clinicians in managing pain for the patients with chronic pain in their end of life care. The effectiveness depends on the type of pain being administered (Hansen, 2005). They may not be used or be less valuable in the management of nerve pain or require relatively higher doses to control such kinds of pain. Most states have developed policies aimed at regulating the use of opioid analgesics to prevent them from being abused. Majority of them require that physicians obtain continuing education that that is related to the prescription of controlled substances, management of pain, and or substance use, abuse and misuse.

Leadership and economic models.

Pain management remains the critical aspect that health care providers have to take care of while delivering their services to individuals. Persistent pain is a multidimensional occurrence and requires comprehensive and various models of care which should be integrated (Arneric et al., 2014). There is increased economic burden in the health sector and state budget at large due to high costs incurred to cater for pain management therapies especially pharmacological therapies. For the care models that exists, there is need to implement various rehabilitative programs that can be either community or home-based to improve the lives of these groups. This will improve their lives and even positively impact their pain perception and management.

From the study during this course, it dawned on me that there are few specialized physicians in the field of pain medicine that can render their services to the high population in the United States that experience chronic pain. This has made services provided by the few health care providers specialized in pain management not only to the geriatric and the substance users but also to the general population. Those experienced in the field are also expensive for individuals such as the aged and the substance users who represent the lower class members of the society. It is due to the shortage and expensive nature of the pain physicians that the primary care physician has continued to play the “surrogate” role of the pain care physicians leading to improper pain care to both the elderly and drug addicts who need special assessment to determine their pain needs.

Working in the field of managing pain has unique challenges as one deals with clients with complex needs hence need for legislative involvement. The administrative personnel plays a key role in ensuring effective and adequate chronic pain management in elderly and drug users in an acute setting as they are involved in making policies and procedures governing the pain management practices by the staff (Arneric et al., 2014). The leaders through sponsoring seminars and researchers can have updated knowledge in the area of managing pain as well as improve their attitude towards older adults and the drug users.

In line with the need of basis of operation and get more information on the pain management of chronic pain among various groups, research projects need to be invested into to guide the pain management. This will led to the development of new models of chronic pain treatment stratification which has been instrumental in pain management to various grouped including the elderly and the drug addicts. This leads to the complexity model that requires a comprehensive pain evaluation that encompasses the assessment of various factors that influence pain manifestation and maintenance of chronic pain which is relevant to the geriatrics and drug addicts whose drug pharmacokinetics and pharmacodynamics have been derailed tampering with pain manifestation and management. It is through this model that pain amongst these groups can be stratified into various levels and lead their management.

Health disparities.

In the chronic pain management, the modality ought to depend on the assessment of the level of the pain by the healthcare providers. However, I have come across presence of ethnic disparities that occur with treatment of pain-related conditions (Ceasar et al., 2016). Most of the pharmacies that I sampled in the minority ethnic groups are not likely to stock potent and adequate analgesics in comparisons to other major ethnic groups who not only form the target by the healthcare systems but also have the financial capability to meet their healthcare needs including pain management to their elderly population as well as the substance users.

There have been negative stereotypes of the minority patients which have also impaired chronic pain control among the geriatrics and the substance users among these groups. This has been attributed to the incompetence surrounding cultural and language differences among the minority patients’ and the healthcare providers. From the knowledge gained in the entire study, I have realized that there is need to empower and support the elderly and the substance users in the minority groups to report pain intensity while the physicians attending to these special groups also need to acknowledge their beliefs systems regarding pain and overcome the stereotypes that are harmful in their care provision (Ceasar et al., 2016).

The elderly and the drug addicts have been stigmatized on their health status and considered a burden to the society. This has deterred the provision of care to them right from the healthcare givers to the societies where they live in. For the geriatrics having multiple problems and determination of their pain needs being cumbersome, the healthcare providers tend to ignore or invalidate their request or cry for pain management.

The drug addicts on the other hands are considered rejects because of their state of substance use. With all these biases, inequality to individuals as well as discrimination towards these two groups, there has been a wide gap between pain assessment and pain management to them. In the long haul, their pain care has not been attended to appropriately leading to poor quality of life to both the geriatrics and the substance users. There is need for implementation of the cultural and language competency training among the healthcare provider to ensure they provide patient centered care.This implementation will allow assessment and consideration of pain management according to their individualized needs.

Apart from the stigmatization especially among the drug addicts, the pain co-occurring with substance abuse particularly in patients using opioids makes it difficult to assess the pain and finally provide treatment to the patient by the healthcare provider. This makes such patients not to receive the appropriate care and continue with their frustrations and suffering.


Pain that persists can deter the functional ability of an individual and irrespective of the origin of the pain; chronic pain requires appropriate treatment that will be effective in the management of pain. This will allow the patient to experience comfort and live the near-normal life. The treatment ranges from opioid use, use of ketamine, psychosocial therapy, antidepressants, and anti-convulsants as well as nerve stimulation. While doing pain care, the side effects of various methods need to be taken into account to ensure efficacy.





Abdulla, A., Adams, N., Bone, M., Elliott, A. M., Gaffin, J., Jones, D., Knaggs, R., … British Geriatric Society. (January 01, 2013). Guidance on the management of pain in older people. Age and Ageing, 42, 1-57.

Arneric, S. P., Laird, J. M., Chappell, A. S., & Kennedy, J. D. (2014). Tailoring chronic pain treatments for the elderly: are we prepared for the challenge?. Drug discovery today, 19(1), 8-17.

Ceasar, R., Chang, J., Zamora, K., Hurstak, E., Kushel, M., Miaskowski, C., & Knight, K. (2016). Primary care providers’ experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings. Substance abuse, 37(1), 154-160.

Hansen, G. R. (January 01, 2005). Management of Chronic Pain in the Acute Care Setting. Emergency Medicine Clinics of North America, 23, 2, 307-338.

Lewis, S. M. (2017). Medical-surgical nursing: Assessment and management of clinical problems.