Division of Geriatrics and Gerontology, Weill Cornell Medical College, New York, New York 10065, USA.
Pain Med. 2010 Oct;11(10):1516-24. doi: 10.1111/j.1526-4637.2010.00950.x. Epub 2010 Sep 7.
Despite new guidelines and nationally mandated regular assessments, managing pain in cognitively impaired patients remains a complex and challenging task. Numerous studies have focused on assessing pain in this population; however, studies of treatment are limited.
The purpose of this article was to characterize assessment and pain management strategies used by providers caring for hospitalized cognitively impaired patients with acute pain, and to assess for associations between amount of opioid received and specific adverse outcomes in this patient population.
Medical records of patients admitted to the Geriatrics Service or Orthopedic Service or evaluated by the Geriatrics Consult Service at an urban tertiary care hospital between September 01, 2006 and September 30, 2007 with cognitive impairment and an acute pain problem on admission were reviewed.
Participants (N=100) had a mean age of 86 years (range=68-99), and were mostly female (83%) with fracture-related pain (62%). A numeric pain score was recorded in 67% of nursing assessments vs <5% of physician assessments. Opioids were prescribed for 100% of the surgical patients vs 43% of the medical patients. Only 15% of patients were placed on a standing analgesic regimen. Nonpharmacological management was employed for 75% of surgical patients vs 43% of medical patients. Delirium occurred in 27% of patients, and 33% experienced an interruption of physical therapy. Neither, however, was associated with level of opioid use.
Current assessment and treatment practices in acute pain management for cognitively impaired patients vary widely (to include service and provider type). Implementation of evidence-based guidelines is needed to improve patient care.
尽管有新的指南和国家强制的定期评估，认知障碍患者的疼痛管理仍然是一项复杂且具有挑战性的任务。许多研究都集中在评估这一人群的疼痛；然而，关于治疗的研究是有限的。
本文的目的是描述照顾住院认知障碍伴有急性疼痛患者的医务人员使用的评估和疼痛管理策略，并评估该患者人群中接受阿片类药物的数量与特定不良结果之间的关系。
对 2006 年 9 月 1 日至 2007 年 9 月 30 日期间在城市三级保健医院老年科、骨科或老年科咨询服务接受评估的，伴有认知障碍和入院时急性疼痛问题的患者的医疗记录进行了回顾。
参与者（N=100）的平均年龄为 86 岁（范围 68-99 岁），大多数为女性（83%），与骨折相关的疼痛（62%）。67%的护理评估记录了数字疼痛评分，而只有不到 5%的医生评估记录了数字疼痛评分。100%的手术患者开了阿片类药物，而只有 43%的内科患者开了阿片类药物。只有 15%的患者接受了持续的止痛治疗方案。75%的手术患者接受了非药物治疗，而只有 43%的内科患者接受了非药物治疗。27%的患者发生了谵妄，33%的患者中断了物理治疗。然而，这两种情况都与阿片类药物的使用水平无关。
认知障碍患者急性疼痛管理的当前评估和治疗实践差异很大（包括服务和提供者类型）。需要实施循证指南以改善患者护理。
