The burden of pain in the elderly population of our society is observed by the greater numbers of the aged who suffer from pain as compared to their younger counterparts. The elderly present difficult challenges for pain clinicians in terms of the ability to assess for pain, amid other medical and pain problems, due to cognitive, sensory, and functional impairment. Treatment with pharmaceuticals may be altered by the impact of aging. Finally, the elderly suffer financial restraints that often prevent optimal treatment of pain even if pain is identified. Principles of pain management in the elderly are reviewed in the context of special attention to assessment tools for the elderly, the evaluation of comorbid factors in the presentation of pain, and pharmacokinetic/pharmacodynamic concerns in the aging. Pharmacologic and nonpharmacologic treatment strategies are described relative to the elder.
Get full access to this article
View all access options for this article.
References
1.
1. McFeatters, Ann “White House Watch: The Mysteries of the Medicare Bill,” Pittsburgh Post-Gazette Sunday Nov 30, 2003.
2.
2. Kelly, Jack “Region’s Lawmakers Recognize Bill’s Benefits, Liabilities,” Pittsburgh Post-Gazette Wednesday Nov 26, 2003.
3.
3. Crook J, Rideout E, Browne G. The prevalence of pain complaints in a general population . Pain. 1984;18(3): 299-314 .
4.
4. Nolan L, O’Malley K. Prescribing for the elderly: part II. Prescribing patterns: differences due to age . J Am Geriatr Soc. 1988;36(3): 245-254 .
5.
5. Ferrell BA. Overview of aging and pain. In: Ferrell BA, Ferrell BR, eds. Pain in the Elderly. Seattle, WA: IASP Press ; 1996:1-10.
6.
6. American Geriatrics Society Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons . J Am Geriatr Soc. 2002;50(6): 1-20 .
7.
7. Ferrell BA, Ferrell BR, Osterweil D. Pain in the nursing home . J Am Geriatr Soc. 1990;38(4): 409-414 .
8.
8. Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients . J Pain Symptom Manag. 1995;10(8): 591-598 .
9.
9. Weiner DK, Rudy TE. Attitudinal barriers to effective treatment of persistent pain in nursing home residents . J Am Geriatr Soc. 2002;50(12): 2035-2040 .
10.
10. Ihara E, Summer L, Shirey L. Challenges for the 21st century: chronic and disabling conditions. Prescription drugs a vital component of health care . Center on an Aging Society. Georgetown University. Sept. 2002;5: 1-6 . Available at: www.aging-society.org. Accessed November 2003.
11.
11. Cooner E, Amorosi S. The Study of Pain in Older Americans. New York, NY: Louis Harris and Associates ; 1997.
12.
12. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy, Institute of Medicine. Washington, DC: National Academies Press ; 2002.
15. Davis MP, Srivastava M. Demographics, assessment, and management of pain in the elderly . Drugs Aging. 2003;20(1): 23-57 .
16.
16. Medling PS. Is there such a thing as geriatric pain? Pain. 1991; 46(2): 119-121 .
17.
17. Weiner DK, Hanlon JT. Pain in nursing home residents: management strategies . Drugs Aging. 2001;18(1): 13-29 .
18.
18. Won A, Lapane S, Vallow J, et al. Analgesic prescribing patterns in elderly nursing home residents with chronic non malignant pain [poster 644]. American Pain Society2003 Abstract Database.
19.
19. American Pain Society releases new clinical guideline for treatment of arthritis pain. March 15, 2002. Available at: www.ampainsoc.org. Accessed November 18, 2003.
20.
20. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain . Arch Neurol. 2003;60: 1524-1534 .
21.
21. Feldman EL, Russell JW, Sullivan KA, Golovoy D. New insights into the pathogenesis of diabetic neuropathy . Curr Opin Neurol. 1999;12(5): 553-563 .
22.
22. Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster . Pain. 1996;67: 241-251 .
23.
23. Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS. Incidence of central post stroke pain . Pain. 1995;61: 187-193 .
24.
24. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population . Arthritis Rheumatism. 1995;38(1): 19-28 .
25.
25. Lash AA, Erlich Jones L, McCoy D. Fibromyalgia: evolving concepts and management in primary care settings . Medsurg Nursing. 2003;12(3): 145-159 .
26.
26. Simon L, Lipman A, Caudil-Slosberg M, et al. Guideline for Management of Chronic Pain in Osteoarthrits, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. 2nd ed. #2 Clinical Practice Guidelines. Glenview, Ill: American Pain Society ; 2003.
27.
27. Jacob A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline No. 9, AHCPR Pub. No. 94-0592. Rockville, Md: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service ; 1994.
28.
28. Maiskowski C, Cleary J, Burney R, et al. Guideline for the Management of Cancer Pain in Adults and Children. Clinical Practice Guideline No. 3. Glenview, Ill: American Pain Society ; 2003.
29.
29. Maiskowski C. The impact of age on a patient’s perception of pain and ways it can be managed . Pain Manag Nurs. 2000;1(3, Suppl. 1): S2-S7 .
31. Schaafsma J, Osoba D. The Karnofsky performance status scale re-examined: a cross-validation with the EORTC-C30 . Qual Life Res. 1994;3(6): 413-424 .
33. Turner N, Scarpace PJ, Lowenthal DT. Geriatric pharmacology: basic and clinical considerations . Annu Rev Pharmacol Toxicol. 1992;32: 271-302 .
34.
34. Wheeler WL, Dickerson ED. Clinical applications of methadone . Am J Hospice Palliat Care. 2000;17(3): 196-202 .
35.
35. Donnelly S, Davis MP, Walsh D, et al. Morphine in cancer pain management: a practical guide . Support Care Cancer. 2002;10: 13-35 .
36.
36. American Medical Association Education for Physicians on End of Life Care Trainer’s Guide. Supported by the Robert Wood Johnson Foundation EPEC Project, 1999, Module 4 Pain Management, Part 1.
37.
37. Helme RD, Gibson SJ. Pain in older people In: Crombie IK, Croft PR, Linton SJ, et al., eds. Epidemiology of Pain. Seattle, Wash: IASP Press ; 1999:103-112.
38.
38. Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs. nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. The CLASS study: a randomized controlled trial . JAMA. 2000;284: 1247-1255 .
39.
39. World Health Organization. Cancer Pain Relief and Palliative Care. World Health Organization Technical Report Series No. 804. Geneva, Switzerland: World Health Organization ; 1990:1-75.
40.
40. Portenoy RK. Chronic opioid therapy for persistent non-cancer pain: can we get past the bias? Am Pain Soc Bull. 1991;1: 4-5 .
41.
41. Harden RN. Chronic opioid therapy: another reappraisal . Am Pain Soc Bull. 2002;12: 8-12 .
42.
42. Portenoy RK. Opioid therapy for chronic non-malignant pain: current status. In: Fields HL, Libeskind JC, eds. Progress in Pain Research and Management. Vol. 1. Seattle, Wash:IASP Press ; 1994:247-288.
43.
43. Pain & Policy Studies. Group annual review of state pain policies. University of Wisconsin . 2000. Available at: www.med-sch.wisc.edu/painpolicy. Accessed November 2003.
44.
44. MSContin package insert. Available at: http://www.mscontin.com. Accessed December 2003. Last updated November 1, 2000.
45.
45. OxyContin package insert. Available at: http://www.oxycontin.com. Accessed December 2003. Last updated July 30, 2003.
46.
46. Kadian package insert. Last updated July 2001.
47.
47 Avinza package insert. Available at: http://www.ligand.com. Accessed December 2003. Last updated February 2003.
48.
48. Morley JS, Makin MK. The use of methadone in cancer pain poorly responsive to other opioids . Pain Rev.1998;5: 51-58 .
49.
49. Weiner DK, Hanlon JT. Pain in nursing home residents: management strategies . Drugs Aging. 2001;18(1): 13-29 .
50.
50. Krantz MJ, Kutinsky IB, Robertson AD, et al. Dose related effects of methadone on QT prolongation in a series of patients with torsade de pointes . Pharmacotherapy. 2003;23(6): 802-805 .
51.
51. Krantz MJ, et al. Torsade de pointes associated with very high dose methadone . Ann Int Med. 2002;137: 501-504 .
52.
52. Gloth FM. Pain management in older adults: prevention and treatment . J Am Geriatr Soc. 2001;49(2): 188-199 .
53.
53. Galer BS, Dworkin RH. A Clinical Guide to Neuropathic Pain. New York, NY: McGraw-Hill ; 2000.
54.
54. Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Lidocaine patch: double blind controlled study of a new treatment method for postherpetic neuralgia . Pain. 1996;65: 39-44 .
55.
55. Gler BS, Rowbotham MC, Perander J, Friedman E. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study . Pain. 1999;80: 553-558 .
56.
56. Landsbury G. Chronic pain management: a qualitative study of elderly people’s preferred coping strategies and barriers to management . Disabil Rehabil. 2000;22(1-2): 2-14 .
