Summary of article by Thomas E. Finucane, MD, "Overview and Critique of the New AGS Guideline for Management of Persistent Pain in Older Adults." Link to full article: WWW.medscape.com/viewarticle/437463_print

This article is an overview and critique of the American Geriatric Society's new guideline. The article reviews the basics of pain management. Persistent pain is a common problem for the elderly but can be measured quantitatively and should be treated as the "fifth vital sign." In 1998 the American Geriatric Society (AGS) published a guideline for the management of chronic pain in the elderly, which addressed the reluctance to treat and undertreatment of pain by physicians. So in 2002 the guideline was updated. The new goals address advice on the management of "persistent" pain in frail and vulnerable elders with limited resources. The new guideline also addresses the significance of the use of Cox-2NSAIDS (non-steroidal anti-inflammatories) as well as mention of the older NSAIDs. the guideline describes four kinds of pain: nocieptive, neuropathic, mixed or unspecified, and psychogenic.

Pain assessment is addressed and the guideline states "All patients (people) . . . should be asked about persistent pain and all individuals who report it should be believed [as] " . . . pain can be measured accurately, and that when present, it generally requires treatment." Recommendations about pharmacotherapy (drug therapy) are reviewed, and recommendations about dosing are discussed relative to age, weight, and other medical circumstances. Opiod analgesia recommendation are made with particular attention to propoxyphene (Darvon), Tramadol (Ultram), and methadone. There is some mention about the use of "Adjuvant" or other drugs and their appropriateness of use for persistent pain. Other concerns, such as breakthrough pain and non-drug strategies, are also mentioned.

The AGS Guideline ends with the following recommendations:

1. Facilities and systems should support policies and procedures that encourage the diagnosis and adequate treatment of pain when it is present.

2. Treatment should be accessible, and reimbursement should be adequate for treatment.

3. Education about  pain management should be emphasized throughout a healthcare system.