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Guidelines
Clinicians should give special attention to the assessment and treatment of pain in special populations, including the very young and very old, cognitively impaired, known or suspected substance abusers, and non-English-speaking persons.
Behavioral observation should be the primary assessment method for preverbal and nonverbal children and used as an adjunct to assessment for verbal children and cognitively impaired adults.
Infants, especially nonventilated, should be closely monitored when they are administered opioids because opioid clearance is prolonged and the blood-brain carrier is more permeable, which increases their potential for opioid-induced sedation and respiratory depression.
The elderly are more vulnerable to drug accumulation because of age-related changes in pharmacokinetics of analgesics; aggressive pain assessment and management are as necessary for them as for younger age groups.
When new psychiatric symptoms occur in a patient with cancer, the possibility of uncontrolled pain should be considered.
Uncontrolled pain, an important factor contributing to feelings of hopelessness, suicidal ideation, and requests for physician-assisted suicide or euthanasia, and therefore should be aggressively assessed and treated.
Because patients with current substance abuse disorders are at risk for undertreatment of cancer pain, their care should be managed by clinicians knowledgeable in both pain management and substance abuse.
Nonopioid analgesic modalities should not be substituted for opioid analgesics to treat severe pain in the suspected or known substance abuser.
When assessing pain or developing a pain treatment plan, health care clinicians should be aware of the unique needs and circumstances of patients from various ethnic and cultural backgrounds.
Because patients with HIV positive/AIDS often have pain problems similar to those of patients with cancer, recommendations for pain assessment and management in this guideline are generally applicable for pain in these patients.
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