Management of Pain in Older Adults in the Opioid and Cannabis Era

Relevance to Physiotherapy

Advocating for optimal pain management for older adults is a key role for physiotherapists. Opioid use remains a common treatment for pain in older adults, particularly in long-term care and they are the fastest-growing group utilizing cannabis. Physiotherapists need to be informed of the risks and benefits of these medications and how they influence care.

Learning Objectives and Session Content

The first portion of this online physiotherapy course will broadly discuss best practices in pain assessment and management in older adults. Speakers will illustrate unique considerations older adults face such as communication challenges, falls risk, frailty, comorbidities, and polypharmacy. The second portion of this online physiotherapy will focus on specific information about the risks and benefits of opioid and cannabis use for pain management. The final portion of the information will discuss the role of physiotherapists in managing pain in older adults who are using opioids or cannabis for pain management.

The Learning Objectives

1. Provide broad practical information about physiotherapy assessment and management principles for older adults living with pain
2. Detail specific issues related to opioid and cannabis use in older adults
3. Define the role of physiotherapists in helping older adults living with pain currently using cannabis and/or opioids for pain management

Description of Supporting Evidence

Older adults are at risk of inadequate pain assessment and management, and there is a high prevalence, particularly in long-term care. There is a common belief that pain in older adults is natural, and should be expected, but these individuals deserve full evaluation, counseling, and support like others. In those receiving treatment, opioid medications remain a common prescription for older adult pain and cannabis has become a popular pain management strategy.

While opioid prescription can be appropriate in some circumstances, clinicians and sufferers of pain should also be aware of increased risk for fractures, cognitive decline and suicide associated with opioids.

1. The increase in the utilization of cannabis is largest in adults over the age of 65 years.
2. While the literature on risks and benefits for using cannabis is limited, there may be side effects with implications for older adults, such as balance impairments.
3. Finally, literature suggests many older adults are either misinformed or under-informed about the use of medications such as opioids and cannabis.
4. Given the key role physical therapists play in the health of older adults, it is important they understand the role of medications such as opioids and cannabis have in managing pain and how they influence rehabilitation. 

Description of Session Format

The 60-minute presentation will include a combination of lecture and opportunities for discussion. Presenters will also incorporate demonstrations of assessment and management strategies throughout.

Conclusions and Implications

Pain assessment and management practices can be improved with attention to the unique considerations facing older adults. Medications such as opioids and cannabis are commonly prescribed, and it is important for physical therapists to understand the risks, benefits and rehabilitation implications for using these medications.

Summary

Pain is often under-treated in older adults. When treated, opioids and cannabis are common treatments. Patients are often under-informed about these medications and they can be associated with important implications for physiotherapy management. Physiotherapists need to be informed on the risks and benefits of these medications and how they influence care.

This course was recorded at the Canadian Physiotherapy Association 2019 Forum in Charlottetown, PEI.