Principles of perioperative pain management in older adults

With the geriatric population, the general rule for dosing is to begin low and go slow. Most interventions will provide relief in hours to minutes. The use of some assessment tool to evaluate the level of pain and whether there has been a change is also important. Monitoring for adverse events is also critical. Patients need to know what to expect and when to expect it before they enter the operating room. Keep the lines of communication open and communicate often, especially in the beginning of a new regimen. Organizations that have traditionally dealt with pain and end-of-life issues are focusing efforts on education, and many are using the access to the internet as a mechanism to get a world-wide message out (Table 3). All of these things make the prospect of better pain management even brighter for the future. Finally, consultation with colleagues in other disciplines or "the pain team," a concept which is becoming more common in the acute hospital setting, is recommended early when pain control is not achieved or when the clinician is uncomfortable with the pain management.