ABSTRACT
The general principles of acute pain management apply to most patients in most acute pain settings. However, there are some groups of patients for whom effective and safe management of pain can be more complex. The chapter focuses on some of these groups, highlighting where concerns may arise and possible changes that might be required in acute pain treatment regimens. Cognitive function declines with age. Patients who have cognitive impairment are known to be at greater risk of under-treatment of acute pain than their cognitively intact counterparts of the same age. The physiological changes are progressive, but the rate of decline can be highly variable as physiological aging may or may not parallel chronological aging. Opioid requirements will often be much higher than “average.” The amount needed can be difficult to judge but it may be three or more times greater in opioid-tolerant patients compared with those who are opioid-naive.
