Presentations
- Burns
- Delirium
- Depression
- Fractures and falls
- Functional decline
- Insomnia
- Postoperative
- Trauma
Conditions
- Acute and chronic neuralgia associated with H. zoster
- Cancer-associated pain
- Diabetic neuropathy
- End-of-life pain
- Fibromyalgia
- Fractures
- Ischaemia
- Musculoskeletal disorders
- Postoperative pain
- Post-stroke pain
- Soft tissue injuries
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Visceral hyperalgesia, such as chronic pancreatitis or irritable bowel syndrome
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Age-related changes in the presentation of pain in older individuals
- Physiologic changes, which lead to outcomes including altered drug absorption and decreased kidney excretion, sensory and cognitive impairments, polypharmacy, and multimorbidity
- The impacts of pain on an older person’s quality of life
- The important aspects of the physical, functional, and psychological assessment of pain
- Major dichotomies
- acute versus chronic pain
- chronic non-cancer pain versus chronic cancer-associated pain
- Somatic descriptors of pain
- neuropathic, such as painful diabetic neuropathy, acute and chronic neuralgia associated with H. zoster, post-stroke pain, some cases of postoperative pain
- nociceptive, such as fractures, soft tissue injuries, osteoarthritis, ischaemia, some cases of post operative pain
- nociplastic, such as “fibromyalgia”, conditions characterised by visceral hyperalgesia such as chronic pancreatitis or irritable bowel syndrome
- Special understanding
- end-of-life pain
- incident pain versus “breakthrough” pain versus background pain
Clinical assessment
- Comprehensive geriatric pain assessment
- Geriatric Depression Scale
- Obtaining proxy data from family members or carers
- Pain assessment tools, including self-report scales and pain behaviour observation tools
- Psychosocial and functional assessment
- Quality of life scale
Investigations
- Imaging
- Nerve conduction studies
- Ageist and discriminatory attitudes toward older people in pain
- Cognitive impairment and the impact on patients’ ability to report pain
- Functioning - e.g. activities of daily living (iADL), social functioning, and sleep
- The impact of chronic pain on function, including reduced mobility, decreased socialisation, sleep disturbance, slow rehabilitation, social isolation, depression, and increased cognitive impairment
- The role of a multidisciplinary team approach for management of persistent pain
- Tools to assess pain - intensity, behaviour, and impact on function and quality of life
- Treatment goals and expectations of patients, family or carers
Non-pharmacological management of pain
- Have an understanding of the evidence for specific non-pharmacological strategies to management pain in older people
- braces
- cognitive behaviour therapy
- exercise
- hydrotherapy
- massage
- physiotherapy
- self-management programs
- supportive psychotherapy
- transcutaneous electrical nerve stimulation (TENS)
Psycho-social aspects of pain and its management
- Engagement with and adherence to treatment
- Identifying attitudes and beliefs about pain, as well as psycho-socio-cultural factors including stoicism and reluctance to confirm the presence of pain
- The importance of psychological factors in pain assessment and management of pain
The role of medications
- Comorbidities and medications in determining impacts on chronic conditions, e.g. some chronic conditions may be worsened by starting a particular analgesic agent, drugs may constitute a contraindication to initiating a specific analgesic trial
- Have an understanding of the evidence for specific classes of medications to treat pain in older people
- adjuvant analgesics
- antidepressants
- opioids
- prescribing ladder
- Issues of drug dependence and up regulation of opioid receptors
- Potential adverse effects of the different classes of drugs used to treat pain
