No abstract

Background: A significant proportion of the elderly are affected by chronic pain, resulting in a decreased quality of life. Opiate use has become increasingly common in older adult patients. This article reviews both well-established current and novel therapies for management of chronic pain in older adults. Areas of Uncertainty: The number of studies involving management of chronic pain in elderly patients is limited. Managing pain alongside multiple chronic, comorbid conditions presents therapeutic and appropriate drug dosing challenges. Therapeutic Advances: Nonsteroidal anti-inflammatory drug nano-formulations have shown promise in clinical trials. These new formulations have similar efficacy to oral nonsteroidal anti-inflammatory drugs, while minimizing adverse effects. TRV130, a new targeted opioid, selectively activates the analgesic pathway of the mu-opioid receptor. The drug has been proven to have analgesic effects similar to morphine with less opioid-induced adverse effects. Mixed opioids agonists, targeting the mu and ORL1 receptors, may prove superior among the opioid class given their effectiveness, improved safety profile, and low abuse potential. In addition, there is ongoing research assessing reduction of pain by targeted and peripherally restricted cannabinoids, attempting to limit activation of the central receptors responsible for addiction and psychotomimetic effects. Conclusions: Management of chronic pain in older adults remains challenging with current medication regimens. In facing the opiate epidemic, providers must use multicomponent strategies to find the most effective and safest combinations of pain medications to achieve adequate pain control. Regardless of the variety and complexity of pain medications available, prescribing physicians should start with low doses, titrate slowly, and monitor pain control frequently. Treating chronic pain is a complex and difficult issue that hopefully will become more manageable as pain medication regimens improve and new therapeutics are developed.