Skip to main content
SpringerLink
Log in

Pain in Older Adults

  • Chapter
  • First Online:
Advances in Chronic and Neuropathic Pain

Part of the book series: Contemporary Rheumatology ((CR))

  • 659 Accesses

Abstract

Pain management in the geriatric population is challenging. The high stakes involved with pain in older adults can be daunting with significant disability due to reduced mobility, falls and anxiety. Chronic pain is widespread and affects up to 25% of the older adult population.

This chapter explores chronic pain in older person and how it differs from the general population. We outline the epidemiology of chronic pain in the elderly and the changes in pain physiology. We discuss the challenging nature of pain assessment and pain management in the geriatric population. In the older adults, a multimodal approach to pain that include both pharmaceutical and non-pharmaceutical modalities is key to optimising clinical outcome. Although the use of physical and psychological rehabilitation to restore function is crucial, we will focus on the use of pharmaceutical treatment and increasing armamentarium of interventional pain strategies for the pain management of the elderly patient.

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 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover 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

Notes

  1. 1.

    Rofecoxib and lumiracoxib have been taken off the market.

Abbreviations

AGS:

American Geriatric Society

COX-2:

Cyclooxygenase-2

NSAID:

Non-steroidal anti-inflammatory drug

SNRI:

Selective and norepinephrine inhibitors or SNRI

TCA:

Tricyclic antidepressant

References

  1. Gibson SJ, Lussier D. Prevalence and relevance of pain in older persons. Pain Med. 2012;13(Suppl 2):S23–6.

    PubMed  Google Scholar 

  2. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain. 2001;89(2–3):127–34.

    CAS  PubMed  Google Scholar 

  3. Stompor M, Grodzicki T, Stompor T, Wordliczek J, Dubiel M, Kurowska I. Prevalence of chronic pain, particularly with neuropathic component, and its effect on overall functioning of elderly patients. Med Sci Monit. 2019;25:2695–701.

    PubMed  PubMed Central  Google Scholar 

  4. Scudds RJ, Mc DRJ. Empirical evidence of the association between the presence of musculoskeletal pain and physical disability in community-dwelling senior citizens. Pain. 1998;75(2–3):229–35.

    CAS  PubMed  Google Scholar 

  5. Duong BD, Kerns RD, Towle V, Reid MC. Identifying the activities affected by chronic nonmalignant pain in older veterans receiving primary care. J Am Geriatr Soc. 2005;53(4):687–94.

    PubMed  Google Scholar 

  6. Welsh TP, Yang AE, Makris UE. Musculoskeletal pain in older adults: a clinical review. Med Clin North Am. 2020;104(5):855–72.

    PubMed  PubMed Central  Google Scholar 

  7. Huang YL, Tsay WI, Her SH, Ho CH, Tsai KT, Hsu CC, et al. Chronic pain and use of analgesics in the elderly: a nationwide population-based study. Arch Med Sci. 2020;16(3):627–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111(1):13–8.

    PubMed  Google Scholar 

  9. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273–e83.

    PubMed  PubMed Central  Google Scholar 

  10. Larsson C, Hansson EE, Sundquist K, Jakobsson U. Chronic pain in older adults: prevalence, incidence, and risk factors. Scand J Rheumatol. 2017;46(4):317–25.

    CAS  PubMed  Google Scholar 

  11. Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain. 2004;20(4):227–39.

    PubMed  Google Scholar 

  12. Lane P, Smith D. Culture, Ageing and the Construction of Pain. Geriatrics (Basel). 2018;3(3):40.

    PubMed  Google Scholar 

  13. Borsheski R, Johnson QL. Pain management in the geriatric population. Mo Med. 2014;111(6):508–11.

    PubMed  PubMed Central  Google Scholar 

  14. Schofield P. The Assessment of Pain in Older People: UK National Guidelines. Age Ageing. 2018;47(suppl_1):i1–i22.

    PubMed  PubMed Central  Google Scholar 

  15. Reid MC, Eccleston C, Pillemer K. Management of chronic pain in older adults. BMJ. 2015;350:h532.

    PubMed  PubMed Central  Google Scholar 

  16. Pautex S, Michon A, Guedira M, Emond H, Le Lous P, Samaras D, et al. Pain in severe dementia: self-assessment or observational scales? J Am Geriatr Soc. 2006;54(7):1040–5.

    PubMed  Google Scholar 

  17. Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain. 2007;23(1 Suppl):S1–43.

    PubMed  Google Scholar 

  18. Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106(3):337–45.

    PubMed  Google Scholar 

  19. Snow AL, Shuster JL Jr. Assessment and treatment of persistent pain in persons with cognitive and communicative impairment. J Clin Psychol. 2006;62(11):1379–87.

    PubMed  Google Scholar 

  20. Cousins MJ, Brennan F, Carr DB. Pain relief: a universal human right. Pain. 2004;112(1–2):1–4.

    PubMed  Google Scholar 

  21. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older P. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–46.

    Google Scholar 

  22. NICE. Osteoarthritis: care and management. National Institute for Health and Care Excellence: London; 2021.

    Google Scholar 

  23. Dunham M, Schofield P, Knaggs R. Evidence-based clinical practice guidelines on the management of pain in older people–a summary report. Br J Pain. 2020:2049463720976155.

    Google Scholar 

  24. Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225.

    PubMed  PubMed Central  Google Scholar 

  25. Ennis ZN, Dideriksen D, Vaegter HB, Handberg G, Pottegard A. Acetaminophen for chronic pain: a systematic review on efficacy. Basic Clin Pharmacol Toxicol. 2016;118(3):184–9.

    CAS  PubMed  Google Scholar 

  26. Ging P, Mikulich O, O'Reilly KMA. Unexpected paracetamol (acetaminophen) hepatotoxicity at standard dosage in two older patients: time to rethink 1 g four times daily? Age Ageing. 2016;45(4):566–7.

    PubMed  Google Scholar 

  27. da Costa BR, Pereira TV, Saadat P, Rudnicki M, Iskander SM, Bodmer NS, et al. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis. BMJ. 2021;375:n2321.

    PubMed  PubMed Central  Google Scholar 

  28. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis. 2018;9(1):143–50.

    PubMed  PubMed Central  Google Scholar 

  29. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.

    PubMed  Google Scholar 

  30. Sabzwari SR, Qidwai W, Bhanji S. Polypharmacy in elderly: a cautious trail to tread. J Pak Med Assoc. 2013;63(5):624–7.

    PubMed  Google Scholar 

  31. Walker C. Are all Oral COX-2 selective inhibitors the same? A consideration of celecoxib, Etoricoxib, and diclofenac. Int J Rheumatol. 2018;2018:1302835.

    PubMed  PubMed Central  Google Scholar 

  32. Ungprasert P, Kittanamongkolchai W, Price C, Ratanapo S, Leeaphorn N, Chongnarungsin D, et al. What is the “safest” non-steroidal anti-inflammatory drugs? Am Med J. 2012;3:115–23.

    CAS  Google Scholar 

  33. Loboz KK, Shenfield GM. Drug combinations and impaired renal function – the ‘triple whammy’. Br J Clin Pharmacol. 2005;59(2):239–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. 2005;352(11):1092–102.

    CAS  PubMed  Google Scholar 

  35. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.

    PubMed  PubMed Central  Google Scholar 

  36. Nissen SE. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2017;376(14):1390.

    PubMed  Google Scholar 

  37. Combe B, Swergold G, McLay J, McCarthy T, Zerbini C, Emery P, et al. Cardiovascular safety and gastrointestinal tolerability of etoricoxib vs diclofenac in a randomized controlled clinical trial (the MEDAL study). Rheumatology (Oxford). 2009;48(4):425–32.

    CAS  PubMed  Google Scholar 

  38. Tugwell PS, Wells GA, Shainhouse JZ. Equivalence study of a topical diclofenac solution (pennsaid) compared with oral diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. J Rheumatol. 2004;31(10):2002–12.

    CAS  PubMed  Google Scholar 

  39. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, et al. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328–35.

    PubMed  PubMed Central  Google Scholar 

  40. Gammaitoni AR, Davis MW. Pharmacokinetics and tolerability of lidocaine patch 5% with extended dosing. Ann Pharmacother. 2002;36(2):236–40.

    CAS  PubMed  Google Scholar 

  41. Attal N, Cruccu G, Haanpää M, Hansson P, Jensen TS, Nurmikko T, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol. 2006;13(11):1153–69.

    CAS  PubMed  Google Scholar 

  42. Ray WA, Meredith S, Thapa PB, Hall K, Murray KT. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther. 2004;75(3):234–41.

    CAS  PubMed  Google Scholar 

  43. 2019 American Geriatrics Society Beers Criteria® Update Expert Panel, et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94.

    Google Scholar 

  44. Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60(11):1524–34.

    PubMed  Google Scholar 

  45. Abou-Raya S, Abou-Raya A, Helmii M. Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial. Age Ageing. 2012;41(5):646–52.

    PubMed  Google Scholar 

  46. Cruccu G, Di Stefano G, Truini A. Trigeminal Neuralgia. N Engl J Med. 2020;383(8):754–62.

    PubMed  Google Scholar 

  47. Battino D, Croci D, Rossini A, Messina S, Mamoli D, Perucca E. Serum carbamazepine concentrations in elderly patients: a case-matched pharmacokinetic evaluation based on therapeutic drug monitoring data. Epilepsia. 2003;44(7):923–9.

    CAS  PubMed  Google Scholar 

  48. Suljic EM, Mehicevic A, Mahmutbegovic N. Effect of long-term carbamazepine therapy on bone health. Med Arch. 2018;72(4):262–6.

    PubMed  PubMed Central  Google Scholar 

  49. Alvarez CA, Mortensen EM, Makris UE, Berlowitz DR, Copeland LA, Good CB, et al. Association of skeletal muscle relaxers and antihistamines on mortality, hospitalizations, and emergency department visits in elderly patients: a nationwide retrospective cohort study. BMC Geriatr. 2015;15:2.

    PubMed  PubMed Central  Google Scholar 

  50. Liu WC, Zheng ZX, Tan KH, Meredith GJ. Multidimensional treatment of cancer pain. Curr Oncol Rep. 2017;19(2):10.

    PubMed  Google Scholar 

  51. Chou R HD, Turner J, Blazina I, Chan B, Levander X, McDonagh M, Selph S, Fu R, Pappas M. Opioid Treatments for Chronic Pain. In: Quality AfHRa, editor. Rockville, MD: AHRQ Publication No. 20-EHC011; 2021.

    Google Scholar 

  52. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49.

    PubMed  Google Scholar 

  53. Arnstein P. Balancing analgesic efficacy with safety concerns in the older patient. Pain Manag Nurs. 2010;11(2 Suppl):S11–22.

    PubMed  Google Scholar 

  54. Kohan L, Potru S, Barreveld A, Sprintz M, Lane O, Aryal A, et al. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med. 2021;46(10):840–59.

    PubMed  Google Scholar 

  55. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Manag. 2004;28(5):497–504.

    CAS  Google Scholar 

  56. Radbruch L, Sabatowski R, Loick G, Kulbe C, Kasper M, Grond S, et al. Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine. Palliat Med. 2000;14(2):111–9.

    CAS  PubMed  Google Scholar 

  57. Heiskanen T, Mätzke S, Haakana S, Gergov M, Vuori E, Kalso E. Transdermal fentanyl in cachectic cancer patients. Pain. 2009;144(1):218–22.

    CAS  PubMed  Google Scholar 

  58. Mattie R, Miller DC, Smith C. On behalf of the spine intervention society’s patient safety C. annual maximum dose of epidural steroid injection. Pain Med. 2019;20(10):2069–70.

    PubMed  Google Scholar 

  59. Dorshkind K, Swain S. Age-associated declines in immune system development and function: causes, consequences, and reversal. Curr Opin Immunol. 2009;21(4):404–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Wang D, Qureshi M, Smith J, Khetani N. Spinal cord compression related to spinal cord stimulator. Pain Med. 2018;19(1):212–4.

    PubMed  Google Scholar 

  61. Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH, et al. Asymptomatic stenosis in the cervical and thoracic spines of patients with symptomatic lumbar stenosis. Global Spine J. 2015;5(5):366–71.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pain Medicine, Singapore General Hospital, Singapore, Singapore

    Christopher W. Liu

  2. Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS, Singapore, Singapore

    Christopher W. Liu

  3. School of Medicine, University of Wollongong, Wollongong, NSW, Australia

    Colin Chun Wai Chong

  4. Department of Radiology, Macquarie University Hospital, Sydney, NSW, Australia

    Colin Chun Wai Chong

  5. Department of Radiology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Colin Chun Wai Chong

Authors
  1. Christopher W. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Colin Chun Wai Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. SMARTMD Philippines, Centuria Medical MakatiMakati City, Philippines

    Jeimylo de Castro

  2. Institute Medical Sciences, Canterbury Christ Church University, Canterbury, Kent, UK

    Yasser El Miedany

Ethics declarations

This manuscript was not supported by any funding.

Conflict of Interest

The authors declare they have no relevant conflicts of interest.

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Liu, C.W., Chong, C.C.W. (2022). Pain in Older Adults. In: de Castro, J., El Miedany, Y. (eds) Advances in Chronic and Neuropathic Pain. Contemporary Rheumatology. Springer, Cham. https://doi.org/10.1007/978-3-031-10687-3_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-10687-3_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-10686-6

  • Online ISBN: 978-3-031-10687-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation