Kennes B
Service de Gériatrie, C.H.U. de Charleroi, Site A. Vésale, Montigny-le-Tilleul, U.L.B.
Rev Med Brux. 2001 Sep;22(4):A330-7.
Pain is a frequent problem in aged population and often undertreated despite undesirable effects such as depression, malnutrition, sleep disturbance, decreased socialization, impaired ambulation with increased risk of falls problems, adverse effects from multiple inadequate drugs prescriptions, cognitive and behaviour impairments. Detection, diagnosis of the causes, evaluation with specific scales and adapted therapy of pain are essential to preserve quality of life and autonomy. Pharmacological therapy using the three-step analgesic ladder of W.H.O. is appropriate owing to individual age-related sensitivity which requires to follow the rule of "start low and go slow" with regular pain and side effects assessments, particularly for opioids. For chronic pain, non pharmacological strategies optimise pain management in addition to medications. Comprehensive geriatric assessment is recommended to complete the global view of the frailed patient with the help of a multidisciplinary team.
疼痛是老年人群中的常见问题，尽管存在诸如抑郁、营养不良、睡眠障碍、社交减少、行走能力受损及跌倒风险增加、多种不适当药物处方的不良反应、认知和行为障碍等不良影响，但疼痛往往未得到充分治疗。疼痛的检测、病因诊断、使用特定量表进行评估以及采用适当的治疗方法对于维持生活质量和自主能力至关重要。由于个体与年龄相关的敏感性，使用世界卫生组织的三阶梯镇痛法进行药物治疗是合适的，对于常规疼痛和副作用评估，尤其是阿片类药物，需要遵循“从小剂量开始，缓慢增加剂量”的原则。对于慢性疼痛，除药物治疗外，非药物策略可优化疼痛管理。建议进行综合老年评估，在多学科团队的帮助下全面了解体弱患者的情况。
