Treatment of Pain in the Older Adult
Bibliographic record
Abstract
Treatment of Pain in the Older Adult Hershl Berman, MD, FRCPC, Department of Internal Medicine, Department of Psychosocial Oncology and Palliative Care, University Health Network,Toronto, ON. Shawna Silver, BASc, PEng, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON. PAIN Strong opioid ± Nonopioid ± Adjuvant Weak opioid ± Nonopioid ± Adjuvant Nonopioid ± Adjuvant 1 2 3 Pain persisting or increasing Pain persisting or increasing Introduction There are a number of challenges to treating pain in older patients. As people age, the number of medical problems they have increases and they tend to be on more prescription drugs.1 Inappropriate prescribing of medications can increase the risk of drug interactions with potentially serious side effects. Before any treatment is started, it is essential to take a complete medication history. Hearing impairment can make it very difficult to get a good history. In addition, mild to severe cognitive impairment may make it impossible to properly treat the patient without assistance. Patients may forget what medications they take, or they may be unable to express themselves. Dementia can lead to difficulties with compliance as well. It is important that an interdisciplinary team approach be taken. The physician may or may not coordinate the team. The pharmacist can be asked to prepare blister packages to help with compliance. A visiting nurse can assess compliance and ensure effective symptom control. Caregivers play a vital role. They spend a lot of time with the patient and can answer questions that the patient cannot. They can bring the patient’s medications, take down instructions, and help to ensure compliance. A final challenge is the ability of the physician. Pain management is poorly taught in medical school and residency. For instance, an unpublished survey distributed by the author in 2001 revealed significant deficiencies in basic knowledge, including assessment of pain and the appropriate use of opioids. The following paper will discuss an approach to pain in the older patient. Although it is similar to the treatment of pain in younger people, there are a few key points that must be noted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".