Rodger Kirsty T M, Greasley-Adams Corinne, Hodge Zoe, Reynish Emma
Department of Geriatric Medicine, NHS Fife, Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, UK.
School of Applied Social Science, University of Stirling, Colin Bell Building, Stirling, FK9 4LA, UK.
BMC Geriatr. 2015 Apr 29;15:56. doi: 10.1186/s12877-015-0056-6.
Hospitalised older patients are complex. Comorbidity and polypharmacy complicate frailty. Significant numbers have dementia and/or cognitive impairment. Pain is highly prevalent. The evidence base for pain management in cognitively impaired individuals is sparse due to methodological issues. A wealth of expert opinion is recognised potentially providing a useful evidence base for guiding clinical practice. The study aimed to gather expert opinion on pain management in cognitively impaired hospitalised older people.
Consultant Geriatricians listed as dementia leads in the National Dementia Audit were contacted electronically and invited to respond. The questionnaire sought information on their role, confidence and approach to pain management in cognitively impaired hospitalised patients. Responses were analysed using a mixed methods approach.
Respondents considered themselves very confident in the clinical field. Awareness of potential to do harm was highly evident. Unequivocally responses suggested paracetamol is safe and should be first choice analgesic, newer opiates should be used preferentially in renal impairment and nefopam is unsafe. A grading of the safety profile of specific medications became apparent, prompting requirement for further evaluation and holistic assessment.
The lack of consensus reached highlights the complexity of this clinical field. The use of paracetamol first line, newer opiates in renal impairment and avoidance of nefopam are immediately transferrable to clinical practice. Further review, evaluation and comparison of the risks associated with other specific analgesics are necessary before a comprehensive clinical guideline can be produced.
住院老年患者情况复杂。合并症和多种药物治疗使衰弱问题更加复杂。相当一部分患者患有痴呆症和/或认知障碍。疼痛非常普遍。由于方法学问题，认知障碍个体疼痛管理的证据基础较为薄弱。大量专家意见被认为可能为指导临床实践提供有用的证据基础。本研究旨在收集关于认知障碍住院老年人疼痛管理的专家意见。
通过电子邮件联系在国家痴呆症审计中被列为痴呆症负责人的老年医学顾问，并邀请他们做出回应。问卷寻求有关他们在认知障碍住院患者疼痛管理中的角色、信心和方法的信息。使用混合方法对回复进行分析。
受访者认为自己在临床领域非常有信心。对潜在危害的认识非常明显。明确的回复表明，扑热息痛是安全的，应作为首选镇痛药；在肾功能损害时应优先使用新型阿片类药物；奈福泮不安全。特定药物安全性概况的分级变得明显，这促使需要进一步评估和全面评估。
缺乏共识凸显了这一临床领域的复杂性。一线使用扑热息痛、在肾功能损害时使用新型阿片类药物以及避免使用奈福泮可立即应用于临床实践。在制定全面的临床指南之前，有必要对与其他特定镇痛药相关的风险进行进一步审查、评估和比较。
