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Pain in the Elderly

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Abstract

Chronic pain can be a common complaint in the elderly population. As the median age of our patient population continues to rise, these patients will likely experience more pain symptoms related to musculoskeletal pathology, cancer, diabetes, and other chronic disorders [1]. It is estimated that between 25% and 50% of community-dwelling elderly have pain complaints [2].There is an even higher prevalence of pain complaints in nursing home patients, estimated between 45% and 80% [3]. The consequences of chronic pain are significant, as it can cause feelings of isolation, depression, sleep impairment, and diminished quality of life. Ultimately, pain related to these chronic conditions contributes significantly toward annual health-care costs and health-care utilization. Although much of these pain complaints related to chronic conditions are not curable, there can still be an emphasis on management of pain in the older patient population. This chapter will review pain in the elderly, looking at the physiology, assessment of pain, pharmacologic, and nonpharmacological treatments.

Keywords

Elderly Aging Cognitive impairment Pain assessment Geriatric pain management Geriatric pharmacology 

References

  1. 1.
    AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6):S205–24.Google Scholar
  2. 2.
    Gloth FM III. Pain management in older adults: prevention and treatment. J Am Geriatr Soc. 2001;49:188–99.CrossRefGoogle Scholar
  3. 3.
    Ferrell BA, Ferrell BR, Osterweil D. Pain in the nursing home. J Am Geriatr Soc. 1990;38:409–14.CrossRefGoogle Scholar
  4. 4.
    Kakigi R. The effect of aging on somatosensory evoked potentials following stimulation of the posterior tibial nerve in man. Electroencephalogr Clin Neurophysiol. 1987;68:227–86.CrossRefGoogle Scholar
  5. 5.
    Hukkanen M, Platts LA, Corbett SA, et al. Reciprocal age-related changes in GAP-43/B-50, substance P and calcitonin gene-related peptide (CGRP) expression in rat primary sensory neurones and their terminals in the dorsal horn of the spinal cord and subintima of the knee synovium. Neurosci Res. 2002;42(4):251–60.CrossRefGoogle Scholar
  6. 6.
    Chakour M, Gibson SJ, Bradbeer M, Helme RD. The effect of age on a delta and C fiber thermal pain perception. Pain. 1996;64:143–52.CrossRefGoogle Scholar
  7. 7.
    Sternbach RA. Clinical aspects of pain. In: Sternbach RA, editor. The psychology of pain. New York: Raven Press; 1978.Google Scholar
  8. 8.
    Ferrell BA. Pain management in long-term care. In: Katz PR, Kane RL, Mezey MD, editors. Quality care in geriatric settings: focus on ethical issues. New York: Springer; 1995. p. 195–209.Google Scholar
  9. 9.
    Parmelee PA. Assessment of pain in the elderly. In: Lawton MP, Teresi J, editors. Annual review of gerontology and geriatrics. New York: Springer; 1994. p. 281–301.Google Scholar
  10. 10.
    Herr KA, Mobily PR, Kohout FJ, Wagenaar D. Evaluation of the faces pain scale for use with elderly. Pain. 1998;14:29–38.Google Scholar
  11. 11.
    Herr K, Mobily P. Comparison of selected pain assessment tools for use with the elderly. Appl Nurs Res. 1993;6:39–46.CrossRefGoogle Scholar
  12. 12.
    Kim EJ, Buschmann MF. Preliability and validity of the faces pain scale with older adults. Int J Nurs Stud. 2006;43:447–56.CrossRefGoogle Scholar
  13. 13.
    D’Arcy Y. How to manage pain in the elderly. Sigma Theta Tau International: Indianapolis; 2010.Google Scholar
  14. 14.
    McCaffery M, Pain BA. Clinical manual for nursing practice. St. Louis: Mosby; 1989. p. 27.Google Scholar
  15. 15.
    American Geriatrics Society Panel on Chronic Pain in Older Persons. AGS clinical practice guidelines: the management of chronic pain in older persons. J Am Geriatr Soc. 1998;46:635–51.CrossRefGoogle Scholar
  16. 16.
    American Medical Directors Association. Chronic pain management in the long-term care setting: clinical practice guideline. Columbia: AMDA; 1999.Google Scholar
  17. 17.
    Bradley JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991;325:87–91.CrossRefGoogle Scholar
  18. 18.
    Gurwitz JH, Avorn J, Ross-Degnan D, Lipsitz LA. Nonsteroidal antiinflammatory drug-associated azotemia in the very old. JAMA. 1990;264:471–5.CrossRefGoogle Scholar
  19. 19.
    Griffin MR, Piper JM, Daugherty JR, et al. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991;114:257–63.CrossRefGoogle Scholar
  20. 20.
    Reisner L. Pharmacological management of persistent pain in older persons. J Pain. 2011 Mar;12(3 Suppl 1):S21–9.CrossRefGoogle Scholar
  21. 21.
    Billups SJ, Delate T, Hoover B. Injury in an elderly population before and after initiating a skeletal muscle relaxant. Ann Pharmacother. 2011 Apr;45(4):485–91.CrossRefGoogle Scholar
  22. 22.
    Ferrell BR. Patient education and nondrug interventions. In: Ferrell BR, Ferrell BA, editors. Pain in the elderly. Seattle: IASP Press; 1996. p. 35–44.Google Scholar
  23. 23.
    Ferrell BR, Ferrell BA, Ahn C, Tran K. Pain management for elderly patients with cancer at home. Cancer. 1994;74:2139–46.CrossRefGoogle Scholar
  24. 24.
    Dillard J, Knapp S. Complementary and alternative pain therapy in the emergency department. Emerg Med Clin North Am. 2005;23:529–49.CrossRefGoogle Scholar
  25. 25.
    Stein WM, Ferrell BA. Pain in the nursing home. Clin Geriatr Med. 1996;12:601–13.CrossRefGoogle Scholar
  26. 26.
    Carr DB, Jacox AK, Chapman CR, et al. Acute pain management: operative or medical procedures and trauma. Clinical Practice Guideline No. 1. AHCPR Pub. No 92–0032. Rockville: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1992.Google Scholar
  27. 27.
    Visser EJ, Ramachenderan J, Davies SJ, Parsons R. Chronic widespread pain drawn on a body diagram is a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies Pain Pract. 2016; 16(1):31–37. 2014 Dec 3.Google Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology, UT Southwestern Medical CenterDallas Veterans HospitalDallasUSA

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