Interventional Strategies for Pain in Older Adults

Pain management in older adults can be quite complex, as one must consider an older person’s cognitive deficits, functional capacity, physical disability, fall risk, and organ function or dysfunction thereof. The most common method of pain control in the ever-increasing elderly population is pharmacotherapy as reported both by patients and their physicians. As a preponderance of patients is placed on multiple pharmacological agents including inflammatory, neuropathic, antidepressant, and opioid medications, the elderly are becoming subject to the complex interactions and risks associated with polypharmacy. Hence, the importance of interventional strategies in these individuals is increasingly being recognized as part of a multimodal approach to pain management. In his review, Ozyalcin proposed that when weak opioids have proven unsuccessful, therapeutic nerve blocks or low-risk neuroablative pain procedures should be employed to help reduce the need for, the medication intake of, and the side effects of stronger opioids. Freedman also agreed that effective pain management in the elderly may be achieved through a multimodal approach with invasive techniques as well as medication and psychological therapy. While there is controversy regarding the efficacy of interventional pain techniques, the quality of medical literature on the specific usefulness of these techniques in the elderly remains relatively poor.