Tramadol, cyclobenzaprine, gabapentin, NSAIDs, oh my!  This episode of focuses on pain management in older adults, specifically pharmacological management of non-cancer related acute inpatient pain. This is part 1 of a two-part series. Part 2 will focus on application of pain management with opioids such as buprenorphine, oxycodone, and dilaudid in older adults. We're joined by Dr. Thomas Chen, MD, PharmD, an assistant professor of medicine and hospitalist at the University of Chicago, with expertise in clinical pharmacology and pharmacogenetics. Dr. Chen discusses the pharmacokinetics and pharmacodynamics changes in older adults that affect pain perception and medication efficacy. He also goes over the rationale for the 'start low and go slow' approach, the controversial use of Tramadol, and the pharmacogenomic considerations in prescribing pain medications like hydrocodone, codeine, gabapentin, cyclobenzaprine, and NSAIDs. Dr. Chen also shares his personal experiences and practical advice for managing pain in a hospital setting while emphasizing the importance of de-prescribing unnecessary medications. SHOW NOTES!!!: HERE As we're focused on management of acute inpatient pain in older adults, underutilized outpatient treatments such as CBT, nerve blocks, injections, and physical therapy are not covered. But many tools exist, with examples below - perfect for your next dotphrase: Many of the nonpharmacological options are outlined on geriatricpain.org, with short "Fast Facts" for patients, developed by the University of Iowa Also on geriatricpain.org is a comprehensive, patient-centered Caregiver Toolkit for assessing pain in your family member with dementia. It goes over Pain Assessment in Advanced Dementia (PAIN AD) Tool, Pain Thermometer, Pain Diary, etc. If you don't want to hog the clinic printer by printing that out, healthinaging.org also provides a shorter caregiver guide for pain. This is even shorter. I-COPE Toolkit: https://voices.uchicago.edu/icope/learn-about-i-cope/ To find CBT for pain management, search American Psychological Association with the patient's zip code and practice area of "Pain Management"   Your state or local county Office for the Aging may also be able to provide resources for support groups for chronic pain. Timestamps 00:00 Introduction to Pain Management in Older Adults 01:45 Meet Dr. Thomas Chen: Background and Expertise 04:32 Understanding Pain Perception and Pharmacokinetics in the Elderly 07:13 The Tramadol Debate: To Use or Not to Use? 11:08 Exploring Alternatives: Hydrocodone and Codeine 13:57 Managing Acute Inpatient Pain: Non-Opioid Approaches 20:04 NSAIDs in Older Adults: Benefits and Risks 24:09 The Role of Acetaminophen and Final Thoughts   Guru: Thomas Chen, MD, PharmD Guest Host/Co-Producer: Hannah O'Hagan, MD (University of Chicago IM PGY2) Show Notes Editor: Kylie McElheran, BS (Oregon Health and Science University MS3) Hosts: Patty Lee, MD, Sam Ing, MD     Guru Bio: Dr. Thomas Chen is an Assistant Professor of Medicine in the Section of Hospital Medicine at The University of Chicago, with a secondary appointment with the Committee on Clinical Pharmacology and Pharmacogenomics. Dr. Chen brings valuable experience as a former pharmacist, utilizing his medication expertise to contribute to research, patient care, and education. In addition to his clinical work as a hospitalist, he is the co-director of the Personalized Therapeutics Clinic, where he conducts extensive medication reviews for drug-drug and drug-gene interactions, also known as pharmacogenomics. Dr. Chen actively engages in research within pharmacy-related areas and pharmacogenomics. He was a co-investigator for the NIH-funded study titled, "Implementation of Point-of-Care Pharmacogenomic Decision Support Accounting for Minority Disparities." Currently, he is a co-investigator for a clinical trial, the "PROTECT-Rx: Evaluating the Effectiveness of a Personalized Therapeutics Clinic Intervention on Drug-Drug Interactions and Drug-Gene Interaction." Show Notes Editor Bio: Kylie McElheran, BS grew up in Grants Pass, OR and is now a third-year medical student at Oregon Health & Science University in Portland, OR. Before medical school, she worked in the clinical research industry for 6 years. In her free time, she loves hanging with her husband and dog, as well as playing board games whilst dabbling in Oregon's superb craft beer scene.  

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