Effect of ibuprofen on cardioprotective effect of aspirin

Chronic Pain in the Elderly: Mechanisms and Perspectives

Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives.

Chronic Pain Management in the Elderly

Chronic pain is extremely prevalent in older adults and is associated with significant morbidity, including limited mobility, social isolation, and depressed mood. Pain is defined by a biopsychosocial model highlighting the importance of a multidisciplinary approach to treatment, including multimodal medications, selected interventions, physical therapy and rehabilitation, and psychological treatments. In this narrative review, the authors highlight the use of these approaches in older adults with specific attention paid to considerations unique to aging, including alterations in drug metabolism, avoidance of polypharmacy, and physiologic changes predisposing to painful conditions.

Severe acute respiratory syndrome

PURPOSE OF REVIEW

Severe acute respiratory syndrome (SARS) is an infectious disease first recognized in November 2002 in Guangdong Province, China. It spread to many countries all over the world during February to June 2003, with 8098 cases reported. Twenty-one percent of the affected people were health care workers. Because SARS is a new emerging disease, this review describes the current understanding about the etiology, clinical pictures, laboratory and radiological findings of SARS.

RECENT FINDINGS

Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) was quickly found to be the etiological agent of SARS in April 2003. The transmission of SARS-CoV between human beings is mainly due to close contact. Using barrier precautions, the transmission of SARS-CoV can be prevented. The most common clinical presentations of patients with SARS include fever, cough, and dyspnea. The common laboratory findings include lymphopenia, thrombocytopenia, elevated serum alanine and aspartate aminotransferase, lactate dehydrogenase, creatine phosphokinase, and C-reactive protein. The most common radiological finding is pneumonic lesion(s) in the chest radiogram. Many patients experience exacerbation of clinical symptoms in the second week of disease course and some may progress to respiratory failure and need mechanical ventilatory support. The overall case fatality rate is 9.6%. The current method of treatment of SARS is still controversial.

SUMMARY

SARS is an infectious disease with high contagiousness and a high mortality rate. Early case identification and infection control are two important factors to limit its spread.