Pharmacological Management of Pain in Older People

Abstract

The prevalence of pain increases with advancing age. Pain is often undiagnosed or under-treated in older patients, particularly those with cognitive impairment, communication problems or residents of aged-care facilities. The most definitive approach to the management of pain is to treat the underlying cause. As this is often not feasible in the elderly, the emphasis then shifts to symptom control. Pharmacological approaches form the mainstay of therapy. They are convenient and often cost-effective, and may be used alone, or in combination with physical and psychological therapies.

Psychological Treatment of Chronic Pain

“…Assessment of pain in older adults with dementia and communication disorders is especially challenging; this topic is addressed in greater detail below. It has been suggested that effective pain management in elderly patients should include both pharmacologic and nonpharmacologic strategies (Ersek et al 2003, Katz 2007. Pharmacologic strategies call for administration of nonopioid analgesics, opioid analgesics, and adjuvant medication.…”

Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Pain in older people

“…All medications must be considered carefully and balanced with regard to risks and benefits for each individual. 'Rational polypharmacy' refers to the concept of using combinations of analgesics with different modes of activity which may be more effective than when used alone and lead to a reduced side effect profile: for example, paracetamol and sustained release oxycodone for moderately severe musculoskeletal pain [42].…”

“…Attempting to achieve total eradication of pain is likely to lead to intolerable side effects. Patient and carer education is vital to assist in setting realistic goals of therapy [42].…”

Thirty years of Geriatric Therapeutics

“…Pain management was reviewed again in 2007 and 2016. In 2007 the cardiovascular risks associated with NSAIDs were noted for the first time, and in the 2016 review it was stated that regular use of NSAIDs is generally not recommended in older people . Reflecting increased awareness of their risks, and availability of a wider range of analgesic options, NSAID usage has fallen over the last 10 years …”

“…In 1998 neuropathic pain was briefly addressed, and carbamazepine, valproate, phenytoin, mexiletene and TCAs were suggested drug therapies . In 2007, gabapentin, pregabalin and lamotrigine were preferred options, with TCAs as a second‐line option . By 2016 additional options were available, including the serotonin‐noradrenaline reuptake inhibitors (e.g.…”