Chronic pain management in older people

Abstract

Successful management of chronic pain in older people is dependent on a careful history and physical examination as it is in young adults. However, detailed attention must also be paid to the effects of co-morbidity on the pain and its treatment, on communication strategies with patients who often have sight and hearing impediments, and on the feasible range of functional outcomes for each patient. Drug interactions are common in older people as they take more medications and have reduced ability to clear most analgesic and adjuvant medications. This suggests a larger than usual role for non-pharmacological management strategies. However, simple analgesics and narcotics are safe to use in older people without overt liver and renal disease, providing the lowest dose compatible with functional improvement is sought; the goal of therapy is to maintain optimum function rather than cure the pain. In general the outcome is positive for both the patient and the practitioner as patients usually respond to medical, physical, psychosocial and cognitive behavioural programmes as well as young adults if given an appropriate milieu, adequate time and empathy.