Fatima Naqvi

Q: How do pain management and wound care intersect?

A: In the US, the crisis of opioid abuse, dependency, overdose and death continues. Controlling the dispensing process in response to the addiction epidemic may have slowed it, but it did not eliminate it.

Mortality data shows that in 2018 approximately 67,000 people died from drug overdose, down from 70,000-plus in 2017. But what do these numbers mean for older adults living with chronic medical conditions in long-term care facilities?

How should I manage the wound pain of a 65-year-old patient who has multiple complex comorbidities versus a 90-year-old male with minimal comorbidities, who still walks three miles every day? Does it matter if the older adult has used recreational drugs in the past?

Pain is not just a subjective finding. It is well known as a biopsychosocial phenomenon that involves physical, mental, emotional and psychosocial components. Often, the main risk factors that predispose one to opioid misuse or addiction are past or current substance abuse, untreated psychiatric disorders, younger age and social or family environments that encourage these behaviors.

The post-acute environment is highly regulated and controlled with the supervision of nursing staff and leaders who monitor controlled substance count, supply, usage and proper disposal, which often minimizes drug diversions and abuse potential.

Pain management in older adults requires a thorough understanding of their age-related physiological changes, comorbidities, polypharmacy, and patient related factors in the particular condition of the wound, be it acute or chronic. Let’s decide together, and treat every patient as a unique individual requiring person-specific care.