Category: Medications

It’s Not Normal: Persistent Pain

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Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

There are many issues facing older adults that are common, but should not be considered inevitable. This blog will launch a series for 2014, all bundled under the general heading of “It’s Not Normal”.  Over the next year, I intend to cover a variety of topics that include dementia, incontinence, falls and depression. If you have suggestions for this series, please leave a comment.

The kick-off for this series is pain. While pain is common as we age, it should never be considered “normal”.  Pain should always be discussed with your healthcare provider, so that he or she can help determine the cause (or causes).  Your healthcare provider can then help you figure out an approach to remove or reduce both the pain and the affect it has on your life.

Acute pain is pain that has happened recently and usually has a known cause. An example of this is a sprained ankle. A few weeks of ice, rest and over the counter pain medications (such as acetaminophen) is usually all that is required for relief to occur.

Chronic or persistent pain, however, is more of a problem. You may have had this pain for some time and the direct cause may not be known.  There are different kinds of chronic pain. These include:

  • pain from nerves, such as diabetic neuropathy or pain from a stroke
  • joint or bone pain such as arthritis or gout
  • some kinds of internal pain, such as abdominal pain from Irritable Bowel Syndrome

American Geriatrics Society Helps You “Choose Wisely”

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This week, the American Board of International Medicine (ABIM) Foundation published the latest of its ground-breaking Choosing Wisely® “five-things” lists, and I’m pleased to report that one of these new lists comes from the American Geriatrics Society. In case you’re not familiar with these important Choosing Wisely lists, here’s a little background:

Two years ago, the ABIM Foundation and Consumer Reports launched the Choosing Wisely campaign to encourage people to learn more about the tests and treatments their healthcare providers recommend, and to question and discuss these with their healthcare professionals under certain circumstances. There are two parts to the Choosing Wisely campaign. Numerous medical societies have gone through an in-depth review process to identify five tests or treatments for which there may not be enough medical research that shows safety or effectiveness. In some cases, the research may even show unwanted effects. At the same time, the Foundation and Consumer Reports have been encouraging people to check the lists to see if tests or treatments their healthcare providers have recommended are on them. If so, the campaign urges people to bring this up with their healthcare professionals and discuss it. Continue reading →

Beers Criteria

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A century ago, the average American could expect to live 50 years or so.  Today, we can expect to live nearly 80. That’s a big jump. What contributed to that big jump in longevity? A lot of things — including the development of medications that prevent and treat serious illnesses like diabetes and heart disease. In addition to all the good they can do, though, drugs can also cause serious side effects and interact with one another in potentially harmful ways. That’s why weighing a medication’s benefits against the risks it poses is so important. It’s particularly important in later life, because age-related physical changes put older adults at particularly high  risk of  drug side effects and other “adverse drug events.”

To help healthcare providers safely prescribe medications for older adults, the American Geriatrics Society (AGS) recently revised, updated and expanded the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The criteria were first published by the late geriatrician Mark Beers, MD, and other experts in 1991, and were revised in 1997 and 2003. They have long been the leading source of information about safe prescribing for adults 65 and older.

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