kelingwang/causation_strength_rating huggingface dataset:
It is important to appropriately classify pain (e.g. acute, chronic, postoperative) to adequately manage it and reduce the associated risks such as falls and behavioural changes.
Managing pain reduces behavioural problems and agitation and enables antipsychotic medicine doses to be reduced or de-prescribed [305].
Management must be tailored to the individual and consists of non-medicines as well as medicines or a combination of both.
A nutritious diet to avoid nutritional deficiencies that contribute to pain and keeping active to avoid muscle wasting are important management strategies.
Non-medicine options often enable lower medication doses to be used and options include cognitive behavioural therapy, relaxation therapies, mediation, transcutaneous electrical nerve stimulation (TENS), heat/cold, exercise, hydrotherapy, massage, acupuncture, and complementary and alternative medicines (e.g. glucosamine) [22,293].
Pain management is different in older people.
It consists of paying meticulous attention to detail and undertaking thorough and regular pain assessments [294].
The 1990 WHO analgesic ladder is a useful decision aid as are the Beer�s criteria [114].
Generally, commence with mild analgesics such as paracetamol and non-medicine options.
Non-steroidal anti-inflammatory medications can be useful for inflammatory pain but older people are sensitive to this class of medicines.
Mild opioids such as codeine and tramadol can be used depending on the type of pain or a combination of medicines.
Strong opioids may be needed at the end of life to promote comfort [306].
Tricyclic antidepressants are often used for neuropathic pain but can cause dry mouth, confusion, postural hypotension, urine retention, and exacerbate or cause glaucoma, especially in frail older people.
Likewise, antiepileptic medicines are effective for neurological pain, but older people may have unpredictable responses.
Common side-effects are gastrointestinal tract bleeding, fluid retention, hypertension, and interact with diuretic blood pressure effects of frusemide and thiazide diuretics [306].
Some older people benefit from lipoic acid 600mg four times per day but the evidence is not strong [307].
Local analgesics such a lidocaine patches and corticosteroids may be useful.
The latter cause muscle wasting and hyperglycaemia, which might outweigh benefits.