Pain Management In Elderly Patients Research Articles

Evolving Concepts of Pain Management in Elderly Patients.

The elderly population typically suffer from a variety of diseases that mostly reflect the degenerative changes linked with the aging process. These diseases may be exacerbated by acute pain or by an abrupt aggravation of previously stable chronic pain. Physical and psychological changes associated with aging may influence one's experience of pain and, as a result, the severity of pain. Pain treatment in the elderly can be complex and is often a budgetary burden on the nation's health care system. These difficulties arise, in part, because of unanticipated pharmacodynamics, changed pharmacokinetics, and polypharmacy interactions. Therefore, it is critical to integrate a multidisciplinary team to develop a management strategy that incorporates medical, psychological, and surgical methods to control persistent pain conditions. It is in this critical process that pain prediction models can be of great use. The purpose of pain prediction models for the elderly is the use of mathematical models to predict the occurrence and intensity of pain and pain-related conditions. These mathematical models employ a vast quantity of data to ascertain the many risk factors for the development of pain problems in the elderly, whether said risks are adjustable or not. These models will pave the way for more informed medical decision making that are based on the findings of thousands of patients who have previously experienced the same illness and related pain conditions. However, future additional research needs to be undertaken to build prediction models that are not constrained by substantial legal or methodological limitations.

Effect of parecoxib on postoperative cognitive function and analgesic safety in elderly patients undergoing gastrointestinal tumor resection: A retrospective study.

Neuroinflammation is associated with the development of postoperative cognitive dysfunction (POCD). Parecoxib has powerful anti-inflammatory and analgesic effects, which may reduce the occurrence of POCD. We hypothesized that parecoxib could reduce the incidence of POCD and relieve postoperative pain without increasing postoperative complications in elderly patients with gastrointestinal cancer. The study analyzed the effect of parecoxib on elderly patients undergoing elective radical resection of gastrointestinal tumors. Patients were divided into the NSAIDs group and the non-NSAIDs group according to whether parecoxib was administered. Demographic and clinical data were collected and compared. The incidence of POCD was set as the primary outcome, and postoperative pain as the secondary outcome. Among the 440 enrolled patients, the POCD incidence rates within 7 days after surgery in the NSAIDs and non-NSAIDs groups were 42.60% and 40.30%, respectively, with no statistically significant difference (P > 0.05). Patients in the NSAIDs group experienced significantly less pain on the first and second days after surgery compared to the non-NSAIDs group (P < 0.05). There were no statistically significant differences in postoperative adverse events between the two groups (P > 0.05). Parecoxib had no significant negative effect on early postoperative cognitive function, effectively alleviating early postoperative acute pain without increasing postoperative complications. The findings have implications for the broader use of parecoxib in postoperative pain management in elderly patients undergoing major surgery.

2280 A QIP to improve pain Management in Elderly Patients presenting with falls to a&amp;E and being referred to the OPAL team

Abstract Introduction Falls account for one of the most common and serious issues contributing to a disability, especially among elderly individuals (1). Injuries resulting from a fall range from mild to severe, but they are all usually painful (2). According to RCEM ‘Recognition and alleviation of pain should be a priority when treating the ill and injured’(3). The aim of this project was to improve pain management in patients with falls being referred to the OPAL team. Studies have shown that patients whose primary pain is well managed and treated in the ED have a higher overall satisfaction with hospital services (4). Method Two PDSA cycles have been completed. Initial data was collected retrospectively from 3/9/23 to 9/9/23 to gather baseline information on current practice. Data was collected from hospital patient’s electronic records. This was followed by teaching sessions and poster distribution to improve staff education highlighting ways to address pain and its management. Post intervention data was collected from 11/12/23–17/12/23. Duplicate records and non-fallers were excluded. Result Initial data was collected on total 75 patients which showed nearly 50% of the patients were in pain when referred to OPAL team. Among the patients in pain, OPAL team advised for pain relief in only 1/3rd of them. Following intervention, data was collected on 57 patients following exclusion. It showed only 26.3% of the patients were in pain at the time of referral, a significant improvement from nearly half in the previous cycle. Also, OPAL team advised regarding pain relief in almost all patients in pain. As a result, 79% of the patient were pain free during OPAL assessment. Conclusion The QIP showed importance of staff education in improving pain management in elderly patients presenting with falls. Further PDSA cycles are planned to sustain the current improvement in practice.

Postoperative pain management in elderly patients: an integrative review

Postoperative pain management in elderly patients: an integrative review

Ultrasound-guided continuous fascia iliaca compartment block for perioperative pain management in elderly patients undergoing hip fracture surgery

To study the effect of ultrasound-guided fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures. A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F) either intravenous analgesia control group(group C). There were 62 cases in group F, including 19 males and 43 females with an average age of (82.4±7.2) years old ranging from 66 to 95 years old, involving 25 femoral neck fractures and 37 femoral intertrochanteric fractures. There were 65 cases in control group, including 18 males and 47 females, with an average age of (81.4±8.7) years old ranging from 65 to 94 years old, involving 29 femoral neck fractures and 36 femoral intertrochanteric fractures. The visual analogue scale(VAS), minimental state examination (MMSE), observer's assessment of alertness/sedation(OAA/S) scale, modified Bromage score, postoperative complications and general conditions during hospitalization in two groups were observed. The resting and exercise VAS at 30 min after block, anesthesia placement and 6, 24 and 48 h after surgery were lower than those in group C(P<0.05). In group F, MMSE scores at 12 h before surgery, and 1, 3 d after surgery and OAA/S scores at 3 d after surgery were higher than those in group C(P<0.05). The incidence of adverse effects and the number requiring additional analgesia were lower than those in group C(P<0.05). Group F had better perioperative analgesia satisfaction and hospital stay than group C(P<0.05). But there was no significant difference regarding Bromage score and 30-day mortality between two group(P>0.05). Ultrasound-guided continuous fascia iliacus space block was safe and effective for elderly patients with hip fracture, and could significantly reduce perioperative pain, improve postoperative cognitive function, and reduce postoperative complications, thereby shortening hospital stay and improving the quality of life during hospitalization.

Comparing the Effectiveness of S-Ketamine Combined with Sufentanil versus Sufentanil Alone for Postoperative Pain Management in Elderly Patients Undergoing Laparoscopic Radical Resection of Gastrointestinal Cancer: A Randomized Controlled Trial

Background. The optimal analgesic dose of S-ketamine after laparoscopic gastrointestinal malignancy surgery remains unclear. This study aimed to evaluate the effect of S-ketamine combined with sufentanil in patient-controlled intravenous analgesia (PCIA) on postoperative pain relief in elderly patients undergoing laparoscopic surgery for gastrointestinal tumors. Methods. Elderly patients undergoing laparoscopic radical resection of gastrointestinal cancer were randomly assigned to one of three postoperative analgesia groups: F group received 2 ug/kg sufentanil in PCIA, LSF group received 0.5 mg/kg S-ketamine and 1.5 ug/kg sufentanil, and SF group received 1 mg/kg S-ketamine and 1 ug/kg sufentanil. The PCIA also contained 0.15 mg/kg of butorphanol and 0.02 mg/kg of ramosetron. Study drugs were administered via PCIA for 48 hours postoperatively. The primary outcome was the accumulated parecoxib sodium requirements within 48 hours after surgery. Results. A total of 105 patients were randomized, and 95 completed the trial (F group: n = 32, LSF group: n = 32, and SF group: n = 31). The cumulative consumption of parecoxib sodium within 48 hours postoperatively was lower in the SF group compared to that in the F group (median difference: −40 mg; 95% confidence interval: −40 to 0; P = 0.0028 ). The number of PCIA compressions within 48 hours after surgery was smaller in the SF group compared to that in the F group. NRS pain scores at 6 h and 12 h postoperatively were reduced in the SF group compared to that in the F group, both at rest and during movement. Compared to the F group, the incidence of postoperative mild depression was lower, the time to first flatus and time to first defecation were shorter, and the incidence of postoperative vomiting was lower in the SF group. The mechanical pain threshold, hyperalgesia area, and sedation scores were similar between the SF and F groups. No differences were observed in the abovementioned parameters between the LSF group and the F group. Conclusion. This trial demonstrated that 1.0 mg/kg S-ketamine combined with 1 ug/kg sufentanil in PCA decreased cumulative parecoxib sodium consumption within 48 hours after laparoscopic radical resection of gastrointestinal cancer in elderly patients.

Management of postoperative pain in the elderly. Literature review

Timely post-operative pain management in elderly patients is critically important. Given their physiological changes and comorbidities, management in this group of patients is different from the rest of the population. Knowledge of potentially inappropriate medications (Beers criteria) is relevant because of the presence of comorbidities in this population. Although acetaminophen continues to be safe, non-steroidal anti-inflammatory agents produce several adverse effects which need to be considered before they are used. On the other hand, opioids continue to be one of the pillars in analgesia, with due consideration of their adverse affects and interactions, and the need for dose adjustments. Adequate postoperative pain management prevents adverse effects and the risk of developing chronic pain.

Measurement of Postoperative Quality of Pain in Abdominoplasty Patients—An Outcome Oriented Prospective Study

(1) Background: Postoperative pain is a frequently underestimated complication significantly influencing surgical outcome and patient satisfaction. While abdominoplasty is one of the most commonly performed plastic surgery procedures, studies investigating postoperative pain are limited in current literature. (2) Methods: In this prospective study, 55 subjects who underwent horizontal abdominoplasty were included. Pain assessment was performed by using the standardized questionnaire of the Benchmark Quality Assurance in Postoperative Pain Management (QUIPS). Surgical, process and outcome parameters were then used for subgroup analysis. (3) Results: We found a significantly decreased minimal pain level in patients with high resection weight compared to the low resection weight group (p = 0.01 *). Additionally, Spearman correlation shows significant negative correlation between resection weight and the parameter "Minimal pain since surgery" (rs = -0.332; p = 0.013). Furthermore, average mood is impaired in the low weight resection group, indicating a statistical tendency (p = 0.06 and a Χ2 = 3.56). We found statistically significant higher maximum reported pain scores (rs = 0.271; p = 0.045) in elderly patients. Patients with shorter surgery showed a statistically significant (Χ2 = 4.61, p = 0.03) increased claim for painkillers. Moreover, "mood impairment after surgery" shows a dramatic trend to be enhanced in the group with shorter OP duration (Χ2 = 3.56, p = 0.06). (4) Conclusions: While QUIPS has proven to be a useful tool for the evaluation of postoperative pain therapy after abdominoplasty, only continuous re-evaluation of pain therapy is a prerequisite for constant improvement of postoperative pain management and may be the first approach to develop a procedure-specific pain guideline for abdominoplasty. Despite a high satisfaction score, we detected a subpopulation with inadequate pain management in elderly patients, patients with low resection weight and a short duration of surgery.

Efficacy of pericapsular nerve group (PENG) block on perioperative pain management in elderly patients undergoing hip surgical procedures: a protocol for a systematic review with meta-analysis and trial sequential analysis

IntroductionAn increasing number of elderly patients suffer from hip diseases associated with moderate to severe perioperative pain during the accelerating global ageing process. Optimal analgesia can decrease perioperative complications and...

The Importance of Personality Traits, Optimism and Quality of Life for Pain Threshold and Pain Tolerance in the Elderly

With increasing age, the frequency of chronic pain increases compared to acute pain. This is due to structural and functional changes caused by ageing of the nervous system. The aim of this study was to investigate relationships between personality traits, optimism, quality of life, and subjective assessment of pain measured experimentally with an algometer and clinically with the Visual Analoque Scale (VAS). In the group of 133 seniors (61-86 years; 78% women), we used an algometer to measure pain threshold and tolerance, the VAS scale to assess subjective intensity, and standardized questionnaires (EPQ-R(s), LOTR, SWLS) to measure psychological variables. Extraversion was found to promote both higher pain threshold and higher pain tolerance, whereas pain tolerance was negatively correlated with neuroticism. Higher severity of the psychotic trait was associated with more intense subjective pain experience. Optimism and overall quality of life were not associated with any pain measures. A better understanding of the personality correlates of pain perception could support a more accurate tailoring of pain management in elderly patients.

Ultrasound Guided Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Block for Perioperative Analgesia in a Patient with Ischemic Heart Disease on Anticoagulants Posted for Corrective Hip Surgery

Introduction : Ultrasound guided pericapsular nerve group block is an approach to block the articular branches of femoral, obturator and accessory obturator nerves that supply the anterior hip capsule and has been found to provide good perioperative analgesia. Case Report: An 86 year old male, who suffered fracture neck of femur after an alleged slip and fall, was posted for emergency corrective surgery. Perioperative evaluation revealed ischemic heart disease, status post PTCA with preserved LV systolic function and on oral anticoagulant rivaroxaban and antiplatelet medication clopidogrel. Coagulation profile was within acceptable range. Cardiac Troponins and Brain Natriuretic peptide (BNP) were measured. General anesthesia was planned to this patient in view of relative contraindication to central neuraxial block i.e. patient being on anticoagulants. Perioperative analgesia was provided with ultrasound guided pericapsular nerve group block for fracture site pain and lateral femoral cutaneous nerve block for surgical incision pain. Patient had stable hemodynamic with improved pain score (VAS &amp; lt; 3) in the immediate postoperative period. There was no evidence of post-operative delirium and perioperative myocardial injury. Conclusion : Ultrasound guided superficial regional nerve group block such as Pericapsular nerve group block, lateral femoral cutaneous nerve block can provide effective postoperative analgesia in patients where central neuraxial blocks are contraindicated. Keywords : Anticoagulants, Hip fracture, Regional anesthesia. Key Messages: Acute pain management in elderly patients is quite challenging to anesthesiologists due to medical comorbidities such as ischemic heart disease patients who experience greater pain are at increase risk in post operative period and patients on anticoagulants where central neuraxial blockade are contraindicated. Perioperative analgesia helps in intraoperative hemodynamic stability and post operative analgesia.

Investigation and Analysis on the Status Quo of Safety Knowledge of Nursing Staff in Elderly Cancer Patients with Cancer Pain

Objective: To investigate the mastery of safety knowledge and methods of nursing staff for cancer pain of elderly patients with cancer and analyze the reasons. Methods: In June, 2019, female nurses were selected from oncology departments of five 3A hospitals in the urban areas and investigated. General data questionnaire, cancer pain management knowledge and attitude questionnaire and case analysis questionnaire were adopted for investigation. Results: The nurses had a good command of the knowledge of cancer pain assessment methods, showing a pass rate of 79.41% and an excellent rate of 45.59%. However, the pass rate of cancer pain-related basic knowledge, analgesic drug knowledge, non-drug pain relief knowledge and cancer pain management methods were 47.06%, 30.88%, 39.71% and 44.12%, respectively, and the excellent rates were 22.06%, 13.24%, 22.06% and 17.65%, respectively. Over 90% of 68 respondents believed that it was necessary and willing to carry out relevant training to improve their self-knowledge level and do a better job in nursing work for the benefit of patients. Meanwhile, more than 85% thought it was necessary to carry out cancer pain knowledge education for patients and their families. In the case analysis questionnaire, there were 45 people qualified, accounting for 66.18% (45/68), and 21 people got the excellent score, accounting for 30.88% (21/68). The factors influencing the knowledge of pain management in elderly patients with cancer pain were education background, professional title of nurse, working years of 11 years or more, participation in relevant training, and average number of nursing cases per month (P&lt;0.05). Conclusion: The safety knowledge of nursing staff for cancer pain of elderly patients with cancer is at the middle level, and the knowledge of analgesic drugs and non-drug pain relief is relatively lacking, which is related to education level, professional title, working years and others. Relevant departments should actively and regularly carry out training to improve their knowledge level, so as to better relieve pain and reduce the risk of extravasation for cancer patients in clinical nursing and escort high-quality nursing.

The Role of Opioids in Pain Management in Elderly Patients with Chronic Kidney Disease: A Review Article.

Chronic kidney disease (CKD) is a global public health problem. Pain is one of the most generally experienced symptoms by CKD patients. Pain management is a key clinical activity; nonetheless, insufficient pain management by health professionals keeps it up. Opioids as pain relievers are a class of naturally-derived and synthetic medications. They act through interactions with receptors in peripheral nerves. Numerous pharmacokinetic alterations happen with aging that influence drug disposition, metabolism, and quality of life. Acetaminophen alone, or combined with low-potency opioid dose is regarded as the safest pain-relieving choice for CKD. Morphine and codeine are probably eluded in renal impairment patients and used with excessive carefulness. Tramadol, oxycodone, and hydromorphone can be used by patient monitoring, while methadone, transdermal fentanyl, and buprenorphine seem to be safe to use in older non-dialysis patients with renal impairment. Consistent with the available literature, the main aim of this review was to explore the occurrence of chronic pain and its opioid treatment in CKD patients. According to this review, more and well-made randomized controlled trials are necessary to find appropriate opioid doses and explore the occurrence of side effects.

Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review

The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12]. Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.

Effects of Dexmedetomidine for postoperative pain management in elderly patients with femoral head replacement

Objective To investigate the effects of different doses of dexmedetomidine combined with sufentanil for postoperative pain management in elderly patients with femoral head replacement(FHR). Methods Between January 2016 and August 2016, 160 elderly patients(>65 years and BMI 20-28 kg/m2)with American Society of Anesthesiologists(ASA)physical classification Ⅰ-Ⅲ scheduled for elective FHR under spinal anesthesia were randomly allocated into four groups(n=40 for each group). Forty patients, who received patient-controlled intravenous analgesia(PCIA)with sufentanil(1.5 μg/kg)and tropisetron(5 mg)diluted by normal saline to 100 ml, were assigned to the control group.The other 120 patients who received Dexmedetomidine in addition to PCIA were allocated to the experimental group.Based on the dose of dexmedetomidine used in PCIA, the experimental group was divided into three subgroups: Group D1(1.0 μg/kg), D2(1.5 μg/kg)and D3(2.0 μg/kg). The background infusion rate was 2 ml/h, demand dose 0.5 ml and lockout interval 15 min.Pain scores at rest were evaluated with a visual analogue scale(VAS)and Ramsay sedation scores were recorded at 4 h, 8 h and 24 h after surgery.Effects of post-operative analgesia and sedation, supplementary doses of analgesics, and adverse events were also recorded and compared. Results Compared with Control group, VAS was significantly lower at 4 h, 8 h and 24 h after surgery in Group D1, D2, and D3(P 0.05). Meanwhile, there were no significant differences in Ramsay scores among the four groups.Doses of supplementary analgesics and rates of adverse events were markedly lower in Group D1, D2 and D3 than in Control group(P<0.05 for all). Conclusions Dexmedetomidine may enhance the analgesic effects of PCIA with sufentanil and reduce the side effects of opioids in elderly patients with FHR. Key words: Dexmedetomidine; Arthroplasty, replacement; Femoral head; Analgesia

Barriers Perceived by Nurses in the Optimal Treatment of Postoperative Pain.

It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. On a national level, the greatest burden of inadequate treatment is borne, among others, by elderly patients. The purpose of the paper was to compare the prevalence of barriers to optimum post-operative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. The research project was a multi-center one and took over a year. The study was questionnaire-based. It used the Polish version of the Nurses’ Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1602 nurses working at a clinical, provincial and municipal hospital.In the university hospital, difficulties in pain assessment related to the healthcare system occurred statistically significantly more often.

Comparative Analysis of Different Methods of Pain Management for Elderly Patients in the Surgical Intensive Care Unit

Summary Background With technological advancements, more elderly patients are undergoing surgery and require care from surgical intensive care units. We aimed to determine the pain management method that provides better acute pain control in all-cause elderly surgical intensive care unit patients. Methods This retrospective cohort study included a chart review of patients treated in a 26-bed surgical intensive care unit from April 2011 through September 2012. The patient exclusion criteria were as follows: unconscious, uncooperative, Results We evaluated 580 patients. The average age was 76 years, and 57% were male. At rest, the patient-controlled epidural analgesia group exhibited significantly lower pain scores (12.06 ± 9.53) compared with the other two groups. During movement, the patient-controlled epidural analgesia and pethidine/nonsteroidal anti-inflammatory drugs groups showed no difference; both exhibited lower pain scores than the patient-controlled analgesia group (41.38 ± 12.5). While coughing, the pethidine/nonsteroidal anti-inflammatory drugs group exhibited lower scores (39.67 ± 24.50) than the patient-controlled epidural analgesia and patient-controlled analgesia groups. The patient-controlled epidural analgesia group showed highest patient satisfaction (4.27 ± 0.51). Stepwise multiple linear regression analysis revealed that patient satisfaction was associated with patient-controlled epidural analgesia (positively) and T-piece trial (negatively). Conclusion Patient-controlled epidural analgesia appears to be a better choice for acute pain management for all-cause elderly surgical intensive care unit patients.

An update on pain management for elderly patients undergoing ambulatory surgery

The aim of this review is to provide an overview of the drugs and techniques used for multimodal postoperative pain management in the older population undergoing surgery in the ambulatory setting. Interest has grown in the possibility of adding adjuncts to a single shot nerve block in order to prolong the local anesthetic effect. The rapid and short-acting local anesthetics for spinal anesthesia are potentially beneficial for day-case surgery in the older population because of shorter duration of the motor block, faster recovery, and less transient neurologic symptoms. Another recent advance is the introduction of intravenous acetaminophen, which can rapidly achieve rapid peak plasma concentration (<15 min) following infusion and analgesic effect in ∼5 min with a duration of action up to 4 h. The nonopioid analgesic therapies will likely assume an increasingly important role in facilitating the recovery process and improving the satisfaction for elderly ambulatory surgery patients. Strategies to avoid the use of opioids and minimize opioid-related side-effects is an important advance as we expand on the use of ambulatory surgery for the aging population.

PAIN IN ELDERLY HAS BEEN OFTEN UNDERESTIMATED

The authors surveyed the clinical data and reviewed the literature on the pain management in elderly patients. The conclusion was made that chronic pain in older age is neglected and analgesia is often insufficient. Data for pharmacokinetic and pharmacodynamic characteristics of widely used analgesic drugs are summarized. The authors provide practical guidelines for pain management of elderly people in outpatients departments. Aging is an inevitable component of life. However, there is no overall accepted definition about an elderly individual. One could be determined as old by physical characteristics, e.g. white or gray hair, changes in social activities, having grandchildren, by changes in occupational status (e.g. being retired) by biological characteristics - e.g. age, etc. An adequate definition should probably contain maximum characteristics of such kind. In this context, it could be assumed that the physiological age can have a more significant impact than the biological one. In the last decades, the age range of all societies has changed to a sustained increase towards older population. According to reliable demographic and sociological calculations, the segment of individuals over the age of 65 in industrial societies will increase from 17.5% in 2000 to 36.3% in 2050 [1]. Retrospective studies performed in the period between years 1983-2003, established that the US population over the age of 65 has increased from 11.7% to 12.4%, and the proportion of individuals over 80 increased from 2.4% to 3.5%. The prognosis is that in 2045 the proportion of these age groups will be 20%, and 7.2% respectively [2]. Within the global population, the proportion of the individuals over 65 increased from 6.9% in 2000 to 7.7% in 2009, and in 2050 will reach 16.7%. The proportion of population aged over 80 is dramatically increasing from 1.2% in 2000 to 1.5% in 2009, and in 2050 will increase more, up to 4.9%. These changes are mainly due to the increased life expectancy, which in 2020 for women will be 80.4 years and for men - 79.5 years [3]. There is a dissonance though between these facts and the data that the raised life expectancy does not actually correlate with wholesome living throughout these years [4]. There is an increased complex co-morbidity in the aging population, among which pain of different variety is a frequent symptom. Epidemiological studies indicate that 40-75% of adult individuals complain of chronic pain of various etiology and pathogenesis, with the largest group composed of elderly women [5]. The prolonged pain is most often a consequence of chronic musculoskeletal disorders, osteoporosis with fractures or fissures, metabolic and neuro-degenerative diseases with neuropathic symptoms, etc. The pharmacotherapy of pain syndromes in adults should be consistent with number of factors complicating the application of conventional analgesic approaches. Adult individuals have reduced nociceptive capabilities, i.e. feel less pain, but tolerate strong and continuous pain syndromes more difficult. They suffer with more than one disease, take many medications of different groups, and rarely report alarming symptoms. Their treatment is complicated by the diminished cognitive capacity in many of them or by the neuropathic pain caused by bone or vertebra fractures, diabetes or other chronic diseases. For the evaluation of pain intensity in elderly patients, different approaches should be used - preferably verbal scales with clear definitions, such as: no-pain, weak-, moderate-, middle-, or severe pain on visual, numerical, picture, mimic and other types of scales [1].

Perception of barriers to postoperative pain management in elderly patients in Polish hospitals - a multicentre study.

The purpose of the paper was to compare the prevalence of barriers to optimum postoperative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. A questionnaire-based study of 1602 nurses working at clinical, provincial and municipal hospitals. In the clinical hospitals barriers more often related to a poorly organised systems of care and obstacles in discussing pain management within the team. In provincial and municipal hospitals lack of uninform pain measurement was more evident. Despite the availability of effective pain treatments in hospitals difficulties continue with communication, poorly organised care and limited access to clinical guidelines. Although there are possibilities of pain relief after surgery, they are still used insufficiently. Postoperative pain management in Poland needs considerable improvement. This study can contribute to the improvement of pain management quality by supporting and developing practical guidelines or management algorithms for nurses, facilitating the effective implementation of new pain management practices.