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老年人持续性疼痛管理的药理学方法:护士需要了解的内容。

Pharmacological Approaches for the Management of Persistent Pain in Older Adults: What Nurses Need to Know.

作者信息

Guerriero Fabio, Bolier Ruth, Van Cleave Janet H, Reid M Cary

出版信息

J Gerontol Nurs. 2016 Dec 1;42(12):49-57. doi: 10.3928/00989134-20161110-09.

DOI:10.3928/00989134-20161110-09
PMID:27898136
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5472205/
Abstract

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Pharmacological Approaches for the Management of Persistent Pain in Older Adults: What Nurses Need to Know" found on pages 49-57, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until November 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe age-related barriers to pain assessment and key aspects of the assessment process. 2. Identify benefits and risks associated with commonly prescribed analgesic medications for the treatment of later life pain. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The current article addresses pharmacological treatment issues regarding the management of persistent pain in later life, which is a worldwide problem associated with substantial disability. Recommendations from guidelines were reviewed and data are presented regarding the benefits and risks of commonly prescribed analgesic medications. The evidence base supports a stepwise approach with acetaminophen as first-line therapy for mild-to-moderate pain. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. In properly selected older patients, opioid drugs should be considered if pain is not adequately controlled. Careful surveillance to monitor for benefits and harms of therapy is critical, given that advancing age increases risk for adverse effects. Key aspects of the pain care process that nurses routinely engage in are covered, including conducting pain assessments prior to initiating therapy, addressing barriers to effective pain care, educating patients and family members about the importance of reducing pain, discussing treatment-related risks and benefits, and formulating strategies to monitor for treatment outcomes. Finally, a case is presented to illustrate issues that arise in the care of affected patients. [Journal of Gerontological Nursing, 42(12), 49-57.].

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f584/5472205/ee00d10dccf6/nihms864035f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f584/5472205/ee00d10dccf6/nihms864035f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f584/5472205/ee00d10dccf6/nihms864035f1.jpg
摘要

如何通过阅读本文获取接触时长说明

维拉诺瓦大学护理学院在成功完成本活动后将授予1.4个接触时长。一个接触时长是一个计量单位,表示60分钟有组织的学习活动。这是一项基于学习者的活动。维拉诺瓦大学护理学院不要求提交测验答案。一旦你注册、支付注册费并在http://goo.gl/gMfXaf在线完成评估表,将授予接触时长证书。为了获得接触时长,你必须:1. 阅读第49 - 57页的文章《老年人持续性疼痛管理的药理学方法:护士需要知道的内容》,仔细留意其中包含的任何表格和其他说明材料,以增强你对内容的知识和理解。务必记录你阅读文章和完成测验所花费的时间(分钟数)。2. 阅读并回答测验中的每个问题。完成所有问题后,将你的答案与本期提供的答案进行比较。如果你有错误答案,请返回文章进一步学习。3. 访问上述维拉诺瓦大学网站注册接触时长学分。你将被要求提供你的姓名、联系信息以及用于支付20美元费用的VISA卡、万事达卡或发现卡卡号。一旦你完成在线评估,证书将自动生成。本活动在2019年11月30日前可用于继续教育学分。接触时长本活动由维拉诺瓦大学护理学院和SLACK公司联合提供。维拉诺瓦大学护理学院被美国护士认证中心认证委员会认可为持续护理教育的提供者。活动目标1. 描述与年龄相关的疼痛评估障碍以及评估过程的关键方面。2. 识别与常用于治疗晚年疼痛的镇痛药物相关的益处和风险。披露声明规划者和作者均无利益冲突需要披露。当前文章讨论了晚年持续性疼痛管理的药理学治疗问题,这是一个与严重残疾相关的全球性问题。回顾了指南中的建议,并给出了常用镇痛药物的益处和风险数据。证据支持以对乙酰氨基酚作为轻至中度疼痛的一线治疗的逐步方法。不建议长期使用口服非甾体抗炎药。在适当选择的老年患者中,如果疼痛未得到充分控制,应考虑使用阿片类药物。鉴于年龄增长会增加不良反应的风险,仔细监测治疗的益处和危害至关重要。涵盖了护士日常参与的疼痛护理过程的关键方面,包括在开始治疗前进行疼痛评估、解决有效疼痛护理的障碍、教育患者和家属关于减轻疼痛的重要性、讨论治疗相关的风险和益处以及制定监测治疗结果的策略。最后给出一个案例来说明受影响患者护理中出现的问题。[《老年护理杂志》,42(12),49 - 57。]

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本文引用的文献

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Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period.术后初期未使用阿片类药物患者慢性阿片类药物使用的发生率及危险因素
JAMA Intern Med. 2016 Sep 1;176(9):1286-93. doi: 10.1001/jamainternmed.2016.3298.
2
Paracetamol for low back pain.对乙酰氨基酚治疗腰痛。
Cochrane Database Syst Rev. 2016 Jun 7;2016(6):CD012230. doi: 10.1002/14651858.CD012230.
3
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis.
阿片类镇痛药治疗腰痛的疗效、耐受性和剂量依赖性效应:系统评价和荟萃分析。
JAMA Intern Med. 2016 Jul 1;176(7):958-68. doi: 10.1001/jamainternmed.2016.1251.
4
CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.美国 2016 年慢性疼痛阿片类药物处方指南。
MMWR Recomm Rep. 2016 Mar 18;65(1):1-49. doi: 10.15585/mmwr.rr6501e1.
5
Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys.局部用非甾体抗炎药治疗骨关节炎的疗效与安全性:来自实际应用试验和调查的证据。
Semin Arthritis Rheum. 2016 Feb;45(4 Suppl):S18-21. doi: 10.1016/j.semarthrit.2015.11.007. Epub 2015 Dec 2.
6
Person-Centered Care: A Definition and Essential Elements.以患者为中心的护理:定义与基本要素
J Am Geriatr Soc. 2016 Jan;64(1):15-8. doi: 10.1111/jgs.13866. Epub 2015 Dec 2.
7
Glucosamine-containing supplement improves locomotor functions in subjects with knee pain: a randomized, double-blind, placebo-controlled study.含葡萄糖胺的补充剂可改善膝关节疼痛患者的运动功能:一项随机、双盲、安慰剂对照研究。
Clin Interv Aging. 2015 Oct 28;10:1743-53. doi: 10.2147/CIA.S93077. eCollection 2015.
8
American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.美国老年医学会2015年更新的《老年人潜在不适当用药的Beers标准》
J Am Geriatr Soc. 2015 Nov;63(11):2227-46. doi: 10.1111/jgs.13702. Epub 2015 Oct 8.
9
Management of chronic pain in older adults.老年人慢性疼痛的管理
BMJ. 2015 Feb 13;350:h532. doi: 10.1136/bmj.h532.
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The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.长期阿片类药物治疗慢性疼痛的效果和风险:美国国立卫生研究院预防途径研讨会的系统评价。
Ann Intern Med. 2015 Feb 17;162(4):276-86. doi: 10.7326/M14-2559.