Skip to main content
SpringerLink
Log in

Interventional Strategies for Pain in Older Adults

  • Chapter
  • First Online:
Effective Treatments for Pain in the Older Patient

  • 967 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ozyalcin NS. Minimal invasive treatment modalities for geriatric pain management. Agri. 2004;16:26–36.

    CAS  PubMed  Google Scholar 

  2. Freedman GM. Chronic pain. Clinical management of common causes of geriatric pain. Geriatrics. 2002;57:36–41.

    PubMed  Google Scholar 

  3. Frymoyer JW, Cats-Baril WL. An overview of the incidence and costs of low back pain. Orthop Clin N Am. 1991;22:263–71.

    CAS  Google Scholar 

  4. Shamie AN. Lumbar spinal stenosis: the growing epidemic. AAOS Now. 2011;5(5):9–11.

    Google Scholar 

  5. Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the medicare population: 1994 to 2001. Spine (Phila Pa 1976). 2007;32(16):1754–60.

    Article  Google Scholar 

  6. Christo PJ, Li S, Gibson SJ, Fine P, Hameed H. Effective treatments for pain in the older patient. Curr Pain Headache Rep. 2011;15(1):22–34.

    Article  PubMed  Google Scholar 

  7. Snyder DL, Doggartt D, Turkelson C. Treatment of degenerative lumbar spinal stenosis. Am Fam Physician. 2004;70:517–20.

    PubMed  Google Scholar 

  8. Botwin K, Gruber R, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis. Am J Phys Med Rehabil. 2002;81:898–905.

    Article  PubMed  Google Scholar 

  9. Tadokoro K, Miyamoto H, Sumi M, Shimomura T. The prognosis of conservative treatments for lumbar stenosis: analysis of patients over 70 years of age. Spine. 2005;30:2458–63.

    Article  PubMed  Google Scholar 

  10. Koc Z, Ozcakir O, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine. 2009;34:985–9.

    Article  PubMed  Google Scholar 

  11. Shabat S, Folman Y, Leitner Y, Fredman B, Gepstein R. Failure of conservative treatment for lumbar stenosis in elderly patients. Arch Gerontol Geriatr. 2007;44:235–4.

    Article  CAS  PubMed  Google Scholar 

  12. Merskey H, Bogduk N. Classification of chronic pain: classifications of chronic pain descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle: IASP Press; 1994. p. 13–5.

    Google Scholar 

  13. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis and the role of epidural steroid injection in management. BJA. 2010;99:461–73.

    Article  CAS  Google Scholar 

  14. Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxica. Spine. 1993;18:1433–8.

    Article  CAS  PubMed  Google Scholar 

  15. Lievre JA, Bloch-Michel H, Pean G. L’hydrocortisone en injection locale. Revue du Rhumatisme et des Maladies Osteo-articulares. 1953;20:310–1.

    Google Scholar 

  16. Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care. 1995;23:564–9.

    CAS  PubMed  Google Scholar 

  17. McQuay H, Moore A. Ch 27: epidural corticosteroids for sciatica. In: An evidenced based resource for pain relief. New York: Oxford University Press; 1998. p. 216–8.

    Google Scholar 

  18. Riew KD, Yuming Y, Gilula L, et al. The effect of nerve root injections on the need for operative treatment of lumbar radicular pain. J Bone Joint Surg Am. 2000;82:1589–3.

    Article  PubMed  Google Scholar 

  19. Bicket MC, Gupta A, Brown CH 4th, Cohen SP. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the “control” injections in randomized controlled trials. Anesthesiology. 2013;119(4):907–31.

    Article  PubMed  Google Scholar 

  20. Helbig T, Lee CK. The lumbar facet syndrome. Spine (Phila Pa 1976). 1988;13(1):61–4.

    Article  CAS  Google Scholar 

  21. Cohen SP, Huang JH, Brummett C. Facet joint pain—advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101–16.

    Article  PubMed  Google Scholar 

  22. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42(Suppl 1):i1–57.

    Article  PubMed  Google Scholar 

  23. Manchikanti L, Pamapti V, Rivera J, Fellow B, Beyer C, Damron K. Role of facet joints in chronic back pain in the elderly: a controlled prevalence study. Pain Pract. 2001;1:332–7.

    Article  CAS  PubMed  Google Scholar 

  24. Manchikanti L, Manchikanti KN, Cash KA, Singh V, Giordano J. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician. 2008;11:67–75.

    PubMed  Google Scholar 

  25. Cohen SP, Raja SN. Pathogenesis, diagnosis and treatment of lumbar zygopophyseal (facet) joint pain. Anesthesiology. 2007;106:591–614.

    Article  PubMed  Google Scholar 

  26. van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N. 12. Pain originating from the lumbar facet joints. Pain Pract. 2010;10(5):459–69.

    Article  PubMed  Google Scholar 

  27. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976). 1999;24(18):1937–42.

    Article  Google Scholar 

  28. Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine (Phila Pa 1976). 2001;26(13):1411–6.

    Article  CAS  Google Scholar 

  29. van Eerd M, Patijn J, Lataster A, et al. Cervical facet pain. Pain Pract. 2010;10:113–23.

    Article  PubMed  Google Scholar 

  30. Ward A, Watson J, Wood P, et al. Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae. Rheumatology (Oxford). 2002;41(1):68–71.

    Article  CAS  Google Scholar 

  31. Walker J. The sacroiliac joint: a critical review. Phys Ther. 1992;72:903–16.

    Article  CAS  PubMed  Google Scholar 

  32. Bernard TN, Cassidy JD. The sacroiliac syndrome. In: Frymoyer JW, editor. Pathophysiology, diagnosis and management. New York: Raven; 1991. p. 2107–30.

    Google Scholar 

  33. Bowen V, Cassidy JD. Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life until the eighth decade. Spine (Phila Pa 1976). 1981;6(6):620–8.

    Article  CAS  Google Scholar 

  34. Vanelderen P, Szadek K, Cohen SP, De Witte J, Lataster A, Patijn J, et al. 13. Sacroiliac joint pain. Pain Pract. 2010;10(5):470–8.

    Article  PubMed  Google Scholar 

  35. Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334–8.

    Article  CAS  PubMed  Google Scholar 

  36. Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101:1440–53.

    Article  PubMed  Google Scholar 

  37. Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99–116.

    Article  CAS  PubMed  Google Scholar 

  38. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of inta-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010;16(12):1285–90.

    Article  PubMed  Google Scholar 

  39. Luukkainen R, Nissila M, Asikainen E, et al. Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy. Clin Exp Rheumatol. 1999;17(1):88–90.

    CAS  PubMed  Google Scholar 

  40. Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Efficacy of perirticular corticosteroi treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002;20(1):52–4.

    CAS  PubMed  Google Scholar 

  41. Rupert MP, Lee M, Manchikanti L, et al. Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician. 2009;12:399–418.

    PubMed  Google Scholar 

  42. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.

    Article  CAS  PubMed  Google Scholar 

  43. Bajaj S, Saag KG. Osteoporosis: evaluation and treatment. Curr Womens Health Rep. 2003;3(5):418–24.

    PubMed  Google Scholar 

  44. Coper C, Atkinson EJ, O’Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res. 1993;7:221–7.

    Article  Google Scholar 

  45. Jensen ME, McGraw JK, Cardella JF, Hirsch JA. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. J NeuroInterv Surg. 2009;1:181–5.

    Article  CAS  PubMed  Google Scholar 

  46. Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166–8.

    CAS  PubMed  Google Scholar 

  47. Yu SW, Yang SC, Kao YH, Yen CY, Tu YK, Chen LH. Clinical evaluation of vertebroplasty for multiple-level osteoporotic spinal compression fracture in the elderly. Arch Orthop Trauma Surg. 2008;128:97–101.

    Article  PubMed  Google Scholar 

  48. Peh WCG, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology. 2002;223:121–6.

    Article  PubMed  Google Scholar 

  49. Mehbod A, Aunoble S, Le Huec JC. Vertebroplasty for osteoporotic spine fracture: prevention and treatment. Eur Spine J. 2003;12(Suppl 2):S155–62.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report. Spine (Phila Pa 1976). 2002;27(19):E419–22.

    Article  Google Scholar 

  51. Krueger A, Bliemel C, Zettl R, et al. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J. 2009;18(9):1257–65.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Do HM, Kim BS, Marcellus ML, Curtis L, Marks MP. Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures. AJNR Am J Neuroradiol. 2005;26:1623–8.

    PubMed  PubMed Central  Google Scholar 

  53. Voormolen MHJ, Mali WPTM, Lohle PNM, et al. Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The vertos study. AJNR Am J Neuroradiol. 2007;28:555–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Layton KF, Thielen KR, Koch CA, et al. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol. 2007;28:683–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Liliang PC, Su TM, Liang CL, Chen HJ, Tsai YD, Lu K. Percutaneous vertebroplasty improves pain and physical functioning in elderly osteoporotic vertebral compression fracture patients. Gerontology. 2005;51:34–9.

    Article  PubMed  Google Scholar 

  56. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085–92.

    Article  PubMed  Google Scholar 

  57. Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with nonsurgical care for vertebral compression fracture (free): a randomised controlled trial. Lancet. 2009;373:1016–24.

    Article  PubMed  Google Scholar 

  58. Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, et al. Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res. 2011;26(7):1627–37.

    Article  PubMed  Google Scholar 

  59. Buchbinder R, Osborne RH, Ebeling PR, et al. Randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–68.

    Article  CAS  PubMed  Google Scholar 

  60. Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Anderson PA, Froyshteter AB, Tontz WL Jr. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28(2):372–82.

    Article  PubMed  Google Scholar 

  62. Han S, Wan S, Ning L, et al. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and nonrandomised controlled trials. Int Orthop. 2011;35:1349–58.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anaesth Analg. 1967;46:489–91.

    CAS  Google Scholar 

  64. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(699):971–9.

    Article  CAS  PubMed  Google Scholar 

  65. Deer T, Masone R. Selection of spinal cord stimulation candidates for the treatment of chronic pain. Pain Med. 2008;9(S1):S82–92.

    Article  Google Scholar 

  66. Mekhail N, Aeshbach A, Stanton-Hicks M. Cost benefit analysis of neurostimulation for chronic pain. Clin J Pain. 2004;20(6):462–8.

    Article  PubMed  Google Scholar 

  67. North RB, Kidd DH, Farrokhi F, et al. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98–106.

    Article  PubMed  Google Scholar 

  68. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1–2):179–88.

    Article  PubMed  Google Scholar 

  69. Pert CB, Snyder SH. Opiate receptor: demonstration in nervous tissue. Science. 1973;179(77):1011–4.

    Article  CAS  PubMed  Google Scholar 

  70. Hall S, Gallagher RM, Gracely E, et al. The terminal cancer patient: effects of age, gender, and primary tumor site on opioid dose. Pain Med. 2003;4(2):125–34.

    Article  PubMed  Google Scholar 

  71. Krames ES. Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manag. 1993;8(1):36–46.

    Article  CAS  Google Scholar 

  72. Smith TJ, Staats PS, Deer T, Stearns LJ, Rauck RL, Boortz-Marx RL, Buchser E, Catala E, Bryce DA, Coyne PJ, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.

    Article  CAS  PubMed  Google Scholar 

  73. Krames E. Clinical realities and economic considerations: patient selection in intrathecal therapy. J Pain Symptom Manag. 1997;14(3S):S3–S13.

    Article  CAS  Google Scholar 

  74. Kalso E, Edwards JE, Moore RA, et al. Opioids in chronic noncancer pain: systematic review of efficacy and safety. Pain. 2004;112(3):372–80.

    Article  CAS  PubMed  Google Scholar 

  75. Patel VB, Manchikanti L, Singh V, et al. Systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain. Pain Physician. 2009;12(2):345–60.

    PubMed  Google Scholar 

  76. The British Pain Society. Intrathecal drug delivery for the Management of Pain and Spasticity in adults; Recommendations for best practice. Prepared on behalf of the British Pain Society in consultation with the Association for Palliative Medicine and the Society of British Neurological Surgeons. London: The British Pain Society, 2008.

    Google Scholar 

  77. Belverud S, Mogilner A, Schulder M. Intrathecal pumps. Neurotherapeutics. 2008;5(1):114–22.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Cohen SP, Dragovich A. Intrathecal analgesia. Anesthesiol Clin. 2007;25(4):863–82. viii

    Article  CAS  PubMed  Google Scholar 

  79. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–99.

    Article  CAS  PubMed  Google Scholar 

  80. Jinks C, Jordan K, Croft P. Osteoarthritis as a public health problem: the impact of developing knee pain on physical function in adults living in the community: (knest 3). Rheumatology. 2007;46:877–81.

    Article  CAS  PubMed  Google Scholar 

  81. Miller JH, White J, Norton TH. The value of intra-articular injections in osteoarthritis of the knee. J Bone Joint Surg Br. 1958;40:636–43.

    Article  PubMed  Google Scholar 

  82. Bellamy N, Campbell J, Robinson V, Gee TL, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005;2:CD005328.

    Google Scholar 

  83. Bellamy N, Campbell J, Welch V, Gee TL, Bourne R, Wells GA. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;2:CD005321.

    Google Scholar 

  84. Modawal A, Ferrer M, Choi HK, Castle JA. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005;54:758–67.

    PubMed  Google Scholar 

  85. Aggarwal A, Sempowski I. Hyaluronic acid injections for knee osteoarthritis. Systematic review of the literature. Can Fam Physician. 2004;50:249–56.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Division of Pain Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Michael Bottros

  2. Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Paul J. Christo

Authors
  1. Michael Bottros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul J. Christo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Optum, Complex Care Management, Pittsburgh, PA, USA

    Grace A. Cordts

  2. Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Paul J. Christo

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Science+Business Media, LLC, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bottros, M., Christo, P.J. (2019). Interventional Strategies for Pain in Older Adults. In: Cordts, G., Christo, P. (eds) Effective Treatments for Pain in the Older Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-8827-3_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-8827-3_8

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-8825-9

  • Online ISBN: 978-1-4939-8827-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation