Much of the previous discussion (patients in whom communication is difficult) applies. In addition, it is important to remember:
- Verbal descriptor scales may be more reliable than visual analogue scales
- Opiate requirements in general are less but significant inter-patient variability persists
- NSAIDs should be avoided. If you must, try a short course of ibuprofen 200 mg three times a day, consider gastroprotection and make them aware of the side-effects
Treatment
Consider:
- Carefully titrated IV morphine for severe pain, starting with a lower initial bolus, e.g. 2 mg and allowing three to four minutes between top-up doses
- Paracetamol as the non-opiate of choice
Learning Bite
NSAIDs should be avoided in the elderly. Start with a lower initial bolus of 2 mg of titrated IV morphine for severe pain in the elderly.