Concerns with chronic analgesic therapy in elderly patients

Of the community-dwelling elderly population, 25-50% can be expected to suffer pain. The elderly population often receives inadequate pain relief due to (1) ignorance of recommended guidelines for pain control and (2) concern among physicians about prescribing appropriate analgesics for elderly patients, who often have other ailments that directly or indirectly affect pain and its management. Management of chronic pain in older patients differs from that in younger patients because of age-related changes in metabolism and an increased likelihood of multiple medication use. Understanding age- related physiologic changes and other principles of pain management in the elderly patient will allow clinicians to reduce suffering successfully. By considering these factors and by choosing analgesics based on receptor activity, mode of action, and adverse-effect profile, better pain control can be achieved. This article reviews the nociceptive and psychologic factors that contribute to pain. Pharmacologic interventions and pitfalls in pain management for the elderly patient also are reviewed.