Nyeri pada individu lanjut usia: perubahan fisiologis serta pilihan analgesik yang rasional

https://doi.org/10.22146/bns.v19i2.69194

Whisnu Nalendra Tama(1*), Abdullah Syafiq Edyanto(2), Yudiyanta Yudiyanta(3)

(1) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


The etiology of pain in the elderly includes degenerative changes, metabolic disorders, and malignancy. In general, the elderly pain threshold increases, but pain tolerance threshold decreases. Pain assessment plays an important role in satisfactory pain management. However, the elderly is often uncooperative and have cognitive impairment. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and DOLOPLUS 2 methods can be used to assess pain in the elderly.

The aging process can cause pharmacokinetic and pharmacodynamic changes in the elderly. Delayed gastric emptying, decreased liver function, decreased plasma protein binding, as well as decreased muscle mass and fat affect pharmacokinetic changes in the elderly. Pharmacodynamic changes in the elderly include a decrease in the number of neurons in the pain modulation system and changes in the number and function of receptors. Pharmacokinetic and pharmacodynamic changes in the elderly need to be considered to prevent side effects occurrence.

The combination of pharmacological and non-pharmacological therapies can be used in the elderly pain management. Various types of pharmacological therapies can be used, including non-opioid analgesics—including non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol—, opioids, and adjuvant drugs such as antiepileptics and antidepressants. This literature review aims to discuss various changes in the elderly that can affect pain management as well as an overview of appropriate analgesic selection for older adults.

 

ABSTRAK

 

Etiologi nyeri pada lansia meliputi perubahan degeneratif, gangguan metabolik, dan keganasan. Secara umum pada lansia ambang batas deteksi nyeri meningkat, tetapi ambang toleransi menurun. Penilaian nyeri memegang peranan penting dalam keberhasilan manajemen. Namun demikian, lansia sering tidak kooperatif dan terjadi gangguan kognitif. Metode Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) dan DOLOPLUS 2 dapat digunakan untuk penilaian nyeri pada lansia.

Proses penuaan dapat menyebabkan perubahan farmakokinetik maupun farmakodinamik pada lansia. Perlambatan pengosongan lambung, penurunan fungsi hepar, penurunan afinitas terhadap protein pengikat di plasma, serta penurunan massa otot dan lemak mempengaruhi perubahan farmakokinetik pada lansia. Perubahan farmakodinamik pada lansia meliputi penurunan jumlah neuron pada sistem modulasi nyeri serta perubahan jumlah dan fungsi reseptor. Perubahan farmakokinetik dan farmakodinamik pada lansia perlu menjadi pertimbangan untuk mencegah risiko efek samping.

Kombinasi terapi farmakologi dan nonfarmakologi dapat digunakan sebagai manajemen nyeri. Berbagai jenis terapi farmakologis dapat digunakan, antara lain analgesik nonopioid—termasuk non-steroidal anti-inflammatory drugs (NSAID) dan parasetamol—, opioid, serta obat ajuvan seperti antiepilepsi dan antidepresi. Tinjauan pustaka ini bertujuan untuk membahas berbagai perubahan dalam individu lanjut usia yang dapat mempengaruhi manajemen nyeri serta gambaran umum pemilihan obat analgesik yang tepat bagi kelompok tersebut.


Keywords


pain management; elderly; analgesics

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References

1. Kementerian Kesehatan Republik Indonesia. Situasi Lanjut Usia (Lansia) di Indonesia. Jakarta Selatan: Pusat Data dan Informasi Kementerian Kesehatan RI; 2016.
2. National Institutes of Health, World Health Organization. Global Health and Ageing. USA: World Health Organization; 2011.
3. Herr KA, Garand L. Assessment and measurement of pain in older adults. Clinics in Geriatric Medicine. 2001;17(3):457–478.
4. Marchand S. Pain and Age. Dalam: The Phenomenon of Pain. Seattle, USA: IASP Press; 2012. p. 237–270.
5. Mitchell C. Assessment and management of chronic pain in elderly people. British Journal of Nursing. 2001;10(5):296–304.
6. Davis MP, Srivastava M. Demographics , assessment and management of pain in the elderly. Drugs Aging. 2003;20(1):23– 57.
7. Karp JF, Shega JW, Morone NE, Weiner DK. Advances in understanding the mechanisms and management of persistent pain in older adults. British Journal of Anaesthesia. 2008;101(1):111–120.
8. Gagliese L, Melzack R. Pain In the Elderly. Dalam: McMahon SB, Koltzenburg M, editor. Wall And Melzack’s Textbook of Pain. Edisi kelima. Philadelphia: Elsevier Churchill Livingstone; 2006.
9. Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clinical In Geriatric Medicine. 2001;17(3):433–456.
10. Larivie M, Goffaux P, Marchand S, Julien N. Changes in pain perception and descending inhibitory controls start at middle age in healthy adults. The Clinical Journal of Pain. 2007;23(6):506–510.
11. Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. The Clinical Journal of Pain. 2004;20(4):220–239.
12. Chakour MC, Gibson SJ, Bradbeer M, Helme RD. The effect of age on A-delta and C-fibre thermal pain perception. Pain. 1996;64(1):143–152.
13. Cruz-Almeida Y, Aguirre M, Sorenson HL, Tighe P, Wallet SM, Riley JL. Age differences in cytokine expression under conditions of health using experimental pain models. Experimental Gerontology. 2015;72:150–156.
14. Zwakhalen SMG, Hamers JPH, Abu-saad HH, Berger MPF. Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools. BMC Geriatrics. 2006;6(1):3.
15. Manfredi PL, Breuer B, Meier DE, Lisbow L. Pain assessment in elderly patients with severe dementia. Journal of Pain and Symptom Management. 2003;25(1):48–52.
16. Edwards RR, Fillingim RB. Age-associated differences in responses to noxious stimuli. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(3):M180- 185.
17. Gloth FM. Pain management in older adults: prevention and treatment. Journal of the American Geriatrics Society. 2001;49(2):188-199.
18. Barkin RL, Beckerman M, Blum SL, Clark FM, Koh E, Wu DS. Should nonsteroidal anti-inflammatory drugs (NSAIDs) be prescribed to the older adult? Drugs & Aging. 2010;27(10):775- 789.
19. Derry S, Moore RA, Rabbie R. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews. 2016;(4).
20. Ali A, Arif AW, Bhan C, Kumar D, Malik MB, Sayyed Z, et al. Managing chronic pain in the elderly: an overview of the recent therapeutic advancements. Cureus. 2018;10(9):e3293.
21. Fitzcharles M, Lussier D, Shir Y. Management of chronic arthritis pain in the elderly. Drugs Aging. 2010;27(6):471–490.
22. Vance CGT, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control : the state of the evidence. Pain Management. 2014;4(3):197–209.
23. Schwan J, Sclafani J, Tawfik VL. Chronic pain management in the elderly. Anesthesiology Clinics. 2019;37(3):547–560.



DOI: https://doi.org/10.22146/bns.v19i2.69194

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