Pain Management in Older Adults in the ED

The podcast explores pain management strategies for older patients in the emergency department, addressing the undertreatment of pain in this population. It identifies challenges such as difficulties in pain assessment for cognitively impaired patients and opiophobia among clinicians. The guest, pain management expert Sergei Motov, highlights the lack of pharmacologic knowledge among ED physicians, exemplified by the over-prescription of hydromorphone. The discussion covers practical approaches, including shared decision-making with patients, titratable analgesics, and the use of topical NSAIDs. It also cautions against the lethal combination of opioids and gabapentin, advocating for morphine sulfate immediate release as the preferred opioid and exploring ketamine as an alternative.