Opioid (Narcotic) Analgesics II: Opioid Agonist-Antagonists
This chapter focuses on special aspects of management of pain in the young and the elderly. Children most certainly experience pain which, similar to adults, is accompanied by considerable stress and anxiety. The nonnarcotic analgesics are effective in the elderly, with the Nonsteroidal anti-inflammatory drugs (NSAIDs) being particularly helpful for arthritic pains. However, the risk of gastric side effects such as ulceration and gastrointestinal bleeding is quite real. The phenothiazines have been used extensively in elderly patients, most often in the nursing home setting for those with senile brain syndromes. The administration of tricyclic antidepressants to geriatric patients, especially those with preexisting cardiovascular disease, can be associated with clinically important orthostatic hypotension. Finally, the appearance of multiple complaints may give the physician the feeling that the discomfort is less than that actually experienced. However, if the basic principles outlined above are kept in mind, there is no reason why pain in the elderly cannot be adequately diagnosed and effectively treated.