Rectal and sublingual administration are alternatives to intramuscular or subcutaneous routes when intravenous access is problematic. All routes other than intravenous require a lag time for absorption into the circulation. Oral administration is convenient and inexpensive. It is appropriate as soon as the patient can tolerate oral intake and is the mainstay of pain management in the ambulatory surgical population. Simple relaxation strategies can be effective in helping to manage pain.
Patients benefit from periodic reinforcement and coaching in the use of relaxation techniques.
Commonly used physical agents include applications of heat and cold, massage, movement, and rest or immobilization. The Clinical Practice Guideline contains a more complete discussion of the special considerations for pain management in the elderly. A summary is provided here. Elderly people often suffer multiple chronic, painful illnesses and take multiple medications. Pain assessment presents unique problems in the elderly, as these patients may exhibit physiologic, psychologic, and cultural changes associated with aging.