Résumé
La prise en charge du sujet âgé algique se distingue de celle d'un adulte jeune dans deux domaines au moins. D'une part l'évaluation de la douleur ne peut bien souvent pas faire appel aux outils couramment employés chez l'adulte jeune, en raison des troubles sensoriels (notamment de la vue) et des déficits cognitifs fréquents dans la population très âgée. D'autre part, la thérapeutique médicamenteuse pose des problèmes particuliers chez de nombreuses personnes âgées. Le recours à des traitements non médicamenteux doit être développé et une approche combinée alliant médicaments et traitements non-médicamenteux est en général la stratégie thérapeutique la plus adaptée.
Summary
Persistent pain is of frequent occurence in the elderly. The treatment of pain in this population can be challenging in several ways. Often, the evaluation of the intensity and quality of the pain, as well as the response to treatment can be difficult because of superimposed sensory deficits (poor eyesight or hearing loss) or cognitive decline. The use of analgesic drugs require careful medical monitoring because of the frequency of co-morbidities, co-medication and altered drug kinetics. Indeed, drug therapy often falls short of it's desired goal due to a high incidence of side effects; non-drug modalities of pain control take new meaning in this age group and should be given close attention.
This is a preview of subscription content, log in via an institution to check access.
Bibliographie
Allegrante J.P.: The role of adjunctive therapy in the management of chronic nonmalignant pain.The Am. J. Med. 101 (suppl 1A), 33S-39S, 1996.
Bonica J.J.: Definitions and taxonomy of pain.In: Bonica J.J. ed.The management of pain, 2nd ed. Lea et Febiger, 18–27, 1990.
Dettli L.: Données pharmacocinétiques pour l'adaptation de la posologie. In: Biollaz J. et coll, ed.Bases de la thérapeutique médicamenteuse. Edition 1996. Bâle: Documed, 12–20, 1996.
Devor M.: Pain mechanisms and pain syndromes.In: Campbell J.N., ed.Pain 1996 — an updated review. Seattle: IASP Press, 103–112, 1996.
Ferrell B.A.: Pain Management in elderly people.JAGS 39, 64–73, 1991.
Griffin M.R., Piper J.M., Doughtery J.R., Snowden M. andRay W.A.: Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons.Ann. Intern. Med. 114, 257–263, 1991.
Harkins S.W., Kwentus J. andPrice D.D.: Pain and suffering in the elderly.In: Bonica J.J., ed.The management of pain, 2nd ed. Lea et Febiger, 552–559, 1990.
Krahenbuhl S. etFollath F.: La pharmacothérapie en gériatrie.In: Biollaz J. et coll, ed.Bases de la thérapeutique médicamenteuse. Edition 1996. Bâle, Documed, 170–173, 1996.
Popp B. andPortenoy R.K.: Management of chronic pain in the elderly: pharmacology of opioids and other analgesic drugs.In: Ferrel B.R., Ferrell B.A., ed.Pain in the elderly. Seattle, WA: International Association for the Study of Pain (IASP) Press, 21–34, 1996.
Rochon P.A., Fortin P.R., Dear K.B., Minaker K.L. etChalmers T.C.: Reporting of age in data in clinical trials of arthritis.Arch. Intern. Med. 153, 243–248, 1993.
Stein W.M.: Cancer pain in the elderly.In: Ferrel B.R., Ferrell B.A., ed.Pain in the elderly. Seattle, IASP Press, 69–80, 1996.