Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
J Pain. 2011 Mar;12(3 Suppl 1):S14-20. doi: 10.1016/j.jpain.2010.11.006. Epub 2011 Feb 5.
Managing persistent pain is challenging, particularly in older adults who often have comorbidities and physiological changes that affect dosing and adverse effect profiles. The latest guideline issued by the American Geriatrics Society in 2009 is an important clinical resource on prescribing analgesics for older adults. This guideline helps form an evidence-based approach to treating persistent pain, along with other current endorsements, such as the relevant disease-specific recommendations by the American College of Rheumatology, the European League Against Rheumatism, and Osteoarthritis Research Society International, as well as opioid-specific guidelines issued by the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards of the United States, and the American Society of Interventional Pain Physicians. Safety is of utmost concern, especially for older adults; these guidelines include key approaches for safe opioid prescribing. Combining analgesics that have multiple mechanisms of action with nonpharmaceutical approaches can be beneficial in providing pain relief. Nontraditional analgesics are also considered on a case-by-case basis, and a few of these options are weakly recommended. Therapies should be initiated at the lowest possible dose and slowly titrated to effect, while tailoring them to the therapeutic and side-effect responses of the individual.
管理持续性疼痛具有挑战性，特别是在老年人中，他们通常存在合并症和生理变化，这会影响剂量和不良反应谱。美国老年医学学会 2009 年发布的最新指南是针对老年人开具镇痛药的重要临床资源。该指南有助于形成一种基于证据的治疗持续性疼痛的方法，以及其他当前的认可，如美国风湿病学会、欧洲抗风湿病联盟和国际骨关节炎研究协会的相关疾病特异性建议，以及美国疼痛学会、美国疼痛医学学院、美国州医学委员会联合会和美国介入性疼痛医师学会发布的阿片类药物特异性指南。安全性是最重要的关注点，特别是对于老年人；这些指南包括安全开具阿片类药物的关键方法。将具有多种作用机制的镇痛药与非药物方法相结合，可能有助于缓解疼痛。也会根据具体情况考虑非传统的镇痛药，并且有一些选择被弱推荐。治疗应从尽可能低的剂量开始，并缓慢滴定至有效剂量，同时根据个体的治疗和副作用反应进行调整。
