Question

You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patient's subsequent care?

1) The patient may want to investigate new alternative pain management options that are outside the United States.
2) The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
3) The patient may want to increase his exercise and activities significantly to create distractions.
4) The patient may want to relocate to long-term care in order to have his ADL needs met.

Answer 1

For an elderly patient with long-term intractable pain, a referral to a neurologist or neurosurgeon to discuss advanced pain-management options may be the most appropriate next step. Exploring interventions such as nerve blocks or neurostimulation might provide relief, with a focus on safety and quality of life.

Step-by-step explanation:

For an 88-year-old man suffering from long-term, intractable pain where first-line pharmacological and nonpharmacological methods have been ineffective, a referral to a neurologist or neurosurgeon is recommended to discuss advanced pain-management options. Understanding the nature of the patient's pain, whether it be neuropathic or inflammatory, is crucial. Given the complexity of treating chronic pain, especially in the elderly where there are greater risks of side effects and complications, clinicians need to balance efficacy with patient safety.

Exploring new treatment modalities may include interventional procedures or advanced therapies such as nerve blocks, radiofrequency ablation, or neurostimulation. The focus should be on improving quality of life and functionality, considering that increased exercise and significant activity may not be realistic or safe for an 88-year-old with severe pain and that relocation to long-term care should be considered only if the individual's activities of daily living (ADLs) cannot be managed at home or with community support.