From the Guidelines
The best way to address and evaluate pain in a 78-year-old active woman is through self-reported assessment that includes functional status, using a numeric rating scale (0-10) as recommended by the most recent and highest quality study 1. This approach provides the most comprehensive and accurate pain evaluation for an older adult who is cognitively intact and able to communicate. Begin by asking the patient to describe her pain using a numeric rating scale (0-10) but expand beyond just numbers to understand how the pain affects her daily activities, mobility, sleep, and quality of life. Some key points to consider when evaluating pain in older adults include:
- Asking specific questions about what activities trigger or worsen pain, what alleviates it, and how it impacts her independence and usual routines.
- Considering the use of other self-report scales, such as the verbal descriptor scale (VDS) or the faces pain scale (FPS), if the patient has difficulty with the numeric rating scale.
- Recognizing that the behavioral pain scale is more appropriate for patients who cannot self-report, such as those with severe cognitive impairment or who are non-verbal. For this active 78-year-old woman, self-reporting combined with functional assessment provides the richest clinical information, allowing for targeted treatment approaches that address both the pain itself and its impact on her life, as supported by previous studies 1. This method respects her autonomy and recognizes that pain management goals for active older adults often focus on maintaining function and independence rather than simply reducing pain scores. It is also important to consider the potential risks and benefits of different pain management strategies, including the use of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and other medications, as discussed in the literature 1.
From the Research
Evaluating Pain in a 78-Year-Old Active Woman
To address and evaluate pain in a 78-year-old active woman, the following methods can be considered:
- Behavioral Pain Scale: This scale assesses pain through observation of behavioral cues, such as facial expressions, body language, and vocalizations 2.
- Pain Numeric Rating Scale: This scale asks patients to rate their pain from 0 to 10, with 0 indicating no pain and 10 indicating the worst possible pain 3.
- Self-Reported Pain: Patients can self-report their pain levels, which can provide valuable information about their subjective experience of pain 4.
Functional Status
Functional status is an important aspect of pain evaluation, as it can impact a patient's quality of life and ability to perform daily activities. Regular exercise and physical activity can help improve functional status and reduce pain in older adults 5. The following guidelines can be considered:
- Physical Activity Guidelines: Older adults should aim for at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week 5.
- Strengthening Activities: Older adults should engage in strengthening activities that involve all major muscle groups at least two days a week 5.
- Balance Exercises: Those at risk of falling should add exercises that help maintain or improve balance 5.
Pain Management
Pain management options for older adults can include non-pharmacological and pharmacological interventions. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be effective alternatives to opioids for acute pain management 4. However, combination therapy using a small amount of opioid together with a nonopioid pain reliever may also be considered 4. Tramadol, a centrally acting weak μ-opioid receptor analgesic, can be used to relieve moderate to severe pain management in patients 2.