Persistent Pain in the Older Adult: Practical Considerations for Evaluation and Management
The world’s population age 65 and over exceeds 600 million, and many of these suffer from persistent pain with its multidimensional impact. The clinical manifestations of persistent pain are often complex and multifaceted, so that total pain elimination generally represents an unrealistic goal. That being said, informed clinicians that incorporate evidence-based approaches can help patients manage their discomfort and its associated impacts. Obtainment of improved pain-related outcomes for older adults integrates sound assessment principles, appreciation of age-associated physiologic changes to pain pathways, and realistic goal setting as part of the treatment plan. Component of a comprehensive pain assessment identifies the underlying pain etiology and pain syndrome (e.g., nociceptive, neuropathic, widespread, etc.), informs pharmacological and non-pharmacological treatments of the underlying etiology along with the discomfort itself, and helps clinicians identify facilitators and barriers to successful pain management. As clinicians assess pain and consider treatment approaches, age-associated physiologic changes in pain transduction, conduction, and transmission along with pain perception and modulation should also be considered. The formulation of personalized treatment plans serves to foster a sense of hope with the ultimate goal of successful adaptation to living with persistent pain. Care plans benefit from stepped-care and multimodal approaches, with both non-pharmacological and pharmacological treatments. Treatments vary by pain syndrome with nociceptive, neuropathic, and widespread pain being the focus of the chapter along with considerations for persons with dementia and the opioid epidemic. Taken together, the incorporation of basic skills in pain assessment and management can substantially reduce the burden of persistent pain in older adults with optimization of function and quality of life.
KeywordsPersistent pain Older adult Pain assessment Goal setting Treatment plan
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