Persistent Pain in the Older Adult: Practical Considerations for Evaluation and Management

  • Alisha HemrajEmail author
  • Monica Malec
  • Joseph W. Shega
  • Debra K. WeinerEmail author


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.


Persistent pain Older adult Pain assessment Goal setting Treatment plan 


  1. Ablin, J., Fitzcharles, M. A., Buskila, D., Shir, Y., Sommer, C., & Hauser, W. (2013). Treatment of fibromyalgia syndrome: Recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evidence-based Complementary and Alternative Medicine, 2013, 485272.PubMedPubMedCentralGoogle Scholar
  2. Achterberg, W. P., Pieper, M., van Dalen-Kok, A. H., et al. (2013). Pain management in patient with dementia. Clinical Interventions in Aging, 8, 1471–1482.PubMedPubMedCentralCrossRefGoogle Scholar
  3. Alford, D. P. (2016). Opioid prescribing for chronic pain – Achieving the right balance through education. NEJM, 374, 301–303.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Al-Quliti, K. W. (2015). Update on neuropathic pain treatment for trigeminal neuralgia: The pharmacological and surgical options. Neurosciences, 20, 107–114.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Alsaadi, S. M., McAuley, J. H., Hush, J. M., & Maher, C. G. (2011). Prevalence of sleep disturbance in patient with low back pain. European Spine Journal, 20, 737–743.PubMedCrossRefPubMedCentralGoogle Scholar
  6. Amenta, F., Zaccheo, D., & Collier, W. L. (1991). Neurotransmitters, neuroreceptors and aging. Mechanisms of Ageing and Development, 61, 249–273.PubMedCrossRefPubMedCentralGoogle Scholar
  7. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63, 2227–2246.CrossRefGoogle Scholar
  8. American Geriatrics Society Panel on Persistent Pain in Older Adults. (2002). The management of persistent pain in older persons. Journal of the American Geriatrics Society, 50, S205–S224.CrossRefGoogle Scholar
  9. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. (2009). Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57, 1331–1346.CrossRefGoogle Scholar
  10. Becker, P. M., & Cohen, H. J. (1984). The functional approach to the care of the elderly: A conceptual framework. Journal of the American Geriatrics Society, 32, 923.PubMedCrossRefGoogle Scholar
  11. Berman, B. M., Lao, L., Langenberg, P., et al. (2004). Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Annals of Internal Medicine, 141, 901–910.PubMedCrossRefGoogle Scholar
  12. Bosley, B. N., Weiner, D. K., Rudy, T. E., & Graneiri, E. (2004). Is chronic non-malignant pain associated with decreased appetite in older adults? Preliminary evidence. Journal of the American Geriatrics Society, 52, 247.PubMedCrossRefGoogle Scholar
  13. Brody, E. M., & Kleban, M. H. (1983). Day-to-day mental and physical health symptoms of older people: A report on health logs. Gerontol, 23, 75–85.CrossRefGoogle Scholar
  14. Casale, R., & Mattia, C. (2014). Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: Focus on 5% lidocaine-medicated plaster. Therapeutics and Clinical Risk Management, 10, 259–268.PubMedPubMedCentralCrossRefGoogle Scholar
  15. CDC. (2016). Promoting health and independence for an aging population at a glance.
  16. Chakour, M. C., Gibson, S. J., Bradbeer, M., & Helme, R. D. (1996). The effect of age on A delta and C-fiber thermal pain perception. Pain, 64(1), 143–152.PubMedCrossRefGoogle Scholar
  17. Chau, D. L., Walker, V., Pai, L., & Cho, L. M. (2008). Opiates and elderly: Use and side effects. Clinical Interventions in Aging, 3, 273–278.PubMedPubMedCentralCrossRefGoogle Scholar
  18. Choy, E. H. S., Mease, P. J., Kajdasz, D. K., et al. (2009). Safety and tolerability of duloxetine in the treatment of patients with fibromyalgia: Pooled analysis of data from five clinical trials. Clinical Rheumatology, 28, 1035–1044.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Cipher, D. J., Clifford, P. A., & Roper, K. D. (2007). The effectiveness of geropsychological treatment in improving pain, depression, behavioral disturbances, functional disability, and health care utilization in long-term care. Clinical Gerontologist, 30, 23–40.CrossRefGoogle Scholar
  20. Cole, L. J., Farrell, M., Gibson, S. J., & Egan, G. F. (2010). Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiology of Aging, 31, 494–503.PubMedCrossRefGoogle Scholar
  21. Derry, S., Rice, A. S. C., Cole, P., Tan, T., & Moore, R. A. (2013). Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews (2), Art. No.: CD007393.
  22. Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain – United States, 2016. Recommendations and Reports, 65, 1–49.PubMedCrossRefGoogle Scholar
  23. Edwards, R. R., Fillingim, R. B., & Ness, T. J. (2003). Age-related differences in endogenous pain modulation: A comparison of diffuse noxious inhibitory controls in healthy older and younger adults. Pain, 101, 155–165.PubMedCrossRefGoogle Scholar
  24. Espi-Lopez, G. V., Ingles, M., Reuscas-Nicolau, M. A., & Moreno-Segura, N. (2016). Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia: A pilot study. Complementary Therapies in Medicine, 28, 1–7.PubMedCrossRefGoogle Scholar
  25. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. (2016). Available at:
  26. Farrell, M. (2012). Age-related changes in the structure and function of brain regions involved in pain processing. Pain Medicine, 13, S37–S43.PubMedCrossRefGoogle Scholar
  27. Ferrell, B. A., Ferrell, B. R., & Osterweil, D. (1990). Pain the nursing home. Journal of the American Geriatrics Society, 38, 409–414.PubMedCrossRefGoogle Scholar
  28. Fine, P. G., & Herr, K. A. (2009). Pharmacologic management of persistent pain in older adults. Clinical Geriatrics, 17, 25–32.Google Scholar
  29. Franceschi, M., Scarcelli, C., Niro, V., et al. (2008). Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: A prospective study of 1,756 patients. Drug Safety, 31, 545–556.PubMedCrossRefPubMedCentralGoogle Scholar
  30. Galicia-Castillo, M. C., & Weiner, D. K. (2014, September 17). Treatment of persistent pain in older adults. Waltham: UpToDate.Google Scholar
  31. Gibson, S. J., & Farrell, M. (2004). A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. The Clinical Journal of Pain, 20, 227–239.PubMedCrossRefPubMedCentralGoogle Scholar
  32. Gilron, I., Chaparro, L. E., Tu, D., Holden, R. R., Miley, R., et al. (2016). Combination of pregabalin with duloxetine for fibromyalgia: A randomized control trial. Pain, 157, 1532–1540.PubMedCrossRefPubMedCentralGoogle Scholar
  33. Hadjistavropoulos, T., Herr, K., Turk, D. C., Fine, P. G., Dworkin, R. H., Helme, R., et al. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. The Clinical Journal of Pain, 23(Suppl 1), 1–43.CrossRefGoogle Scholar
  34. Hanlon, J. T., Guay, D. R. P., & Ives, T. J. (2005). Oral analgesics: efficacy, mechanism of action, pharmacokinetics, adverse effects, drug interactions and practical recommendations for use in older adults. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons, progress in pain research and management. Seattle: IASP Press.Google Scholar
  35. He, W., Goodkind, D., & Kowal, P. (2016). An aging world: 2015. International Population Reports [on-line]. Available at Accessed 15 Dec 2016.
  36. Herr, K., Coyne, P. J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Management Nursing, 12, 230–250.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Herr, K., Zwakhalen, S., & Swafford, K. (2016). Observation of pain in dementia. Current Alzheimer Research [published online ahead of print].Google Scholar
  38. Hochberg, M. C., Altman, R. D., April, K. T., Benkhalti, M., et al. (2012). American College of Rheumatology 2012 recommendations for the use of non-pharmacological and pharmacological therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 64, 465–474.CrossRefGoogle Scholar
  39. Hodgson, N. A., & Anderson, S. (2008). The clinical efficacy of reflexology in nursing home residents with dementia. Journal of Alternative and Complementary Medicine, 14, 269–275.PubMedCrossRefPubMedCentralGoogle Scholar
  40. Hollingshed, J., Duhmke, R. M., & Comblath, D. R. (2006, July 19). Tramadol for neuropathic pain. Cochrane Database of Systematic Reviews, (3), CD006146.Google Scholar
  41. Husebo, B. S., Ballard, C., Sandvik, R., Nilsen, O. B., & Aarsland, D. (2011). Efficiency of treating pain to reduce behavioral disturbances in residents of nursing homes with dementia: Cluster randomized clinical trial. BMJ, 343, 1–10.CrossRefGoogle Scholar
  42. Ifuku, M., Iseki, M., Hidaka, I., Morita, Y., Komatus, S., & Inada, E. (2011). Replacement of gabapentin with pregabalin in postherpetic neuralgia therapy. Pain Medicine, 12, 1112–1116.PubMedCrossRefPubMedCentralGoogle Scholar
  43. Ing, M. R., Hellreich, P. D., Johnson, D. W., & Chen, J. J. (2015). Transcutaneous electrical nerve stimulation for chronic post-herpetic neuralgia. International Journal of Dermatology, 54, 476–480.PubMedCrossRefPubMedCentralGoogle Scholar
  44. Institute of Medicine Committee on Advancing Pain Research, Care, and Education. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press (US).Google Scholar
  45. Karp, J. F., Reynolds, C. F., 3rd, Butters, M. A., et al. (2006). The relationship between pain and mental flexibility in older adult pain clinic patients. Pain Medicine, 7, 444.PubMedCrossRefPubMedCentralGoogle Scholar
  46. Karp, J. F., Shega, J. W., Morone, N. E., & Weiner, D. K. (2008). Advances in understanding the mechanisms and management of persistent pain in older adults. British Journal of Anaesthesia, 101(1), 111–120.PubMedPubMedCentralCrossRefGoogle Scholar
  47. Kuehn, B. M. (2009). FDA focuses on drugs and liver damage: Labeling and other changes for acetaminophen. JAMA, 302, 369–371.PubMedCrossRefPubMedCentralGoogle Scholar
  48. Larsson, A., Palstam, A., Lofgren, M., Ernerg, M., Bjersing, J., et al. (2015). Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia – Randomized controlled trial. Arthritis Research & Therapy, 17, 161–176.CrossRefGoogle Scholar
  49. Levy, B., Paulozzi, L., Mack, K. A., & Jones, C. M. (2015). Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. American Journal of Preventive Medicine, 49, 409–413.PubMedPubMedCentralCrossRefGoogle Scholar
  50. Lobo, E. D., Quinlin, T., O’Brien, L., Knadler, M. P., & Heathman, M. (2009). Population pharmacokinetics of orally administered duloxetine in patients. Clinical Pharmacokinetics, 48, 189–197.PubMedCrossRefGoogle Scholar
  51. Mailis-Gagnon, A., Nicholson, K., Yegneswara, B., et al. (2008). Pain characteristics of adults 65 years of age and older referred to a tertiary care pain clinic. Pain Research & Management, 13, 389–394.CrossRefGoogle Scholar
  52. Malec, M., & Shega, J. (2015). Pain management in the elderly. Medical Clinics of North America, 99, 337–350.PubMedCrossRefGoogle Scholar
  53. Mason, L., Moore, R. A., Edwards, J. E., et al. (2004). Topical NSAIDs for chronic musculoskeletal pain: Systematic review and meta-analysis. BMC Mulsculoskeletal Disorders, 5, 28.CrossRefGoogle Scholar
  54. McNicol, E., Midbari, A., & Eisenberg, E. (2013). Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, (8), Art. No.: CD006146.
  55. Mease, P., Arnold, L. M., Choy, E. H., Clauw, D. J., Crofford, L., et al. (2009). Fibromyalgia syndrome module at OMERACT 9. The Journal of Rheumatology, 36, 2318–2329.PubMedPubMedCentralCrossRefGoogle Scholar
  56. Menzies, V. (2016). CE: Fibromyalgia syndrome: Current consideration in symptom management. American Journal of Nursing, 116, 24–32.PubMedCrossRefGoogle Scholar
  57. Morone, N. E., Greco, C. M., Moore, C. G., et al. (2016). A mind-body program for older adults with chronic low back pain: A randomized clinical trial. JAMA Internal Medicine, 176, 329–337.PubMedPubMedCentralCrossRefGoogle Scholar
  58. Morrison, R. S., & Siu, A. L. (2000). A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. Journal of Pain and Symptom Management, 19, 240–248.PubMedCrossRefGoogle Scholar
  59. Mylius, V., Kunz, M., Henninghausen, E., Lautenbacher, S., & Schepelmann, K. (2008). Effects of ageing on spinal motor and autonomic pain responses. Neuroscience Letters, 446, 129–132.PubMedCrossRefGoogle Scholar
  60. Neumann-Podczaska, A., et al. (2016). Analgesic use among nursing home residents, with and without dementia in Poland. Clinical Interventions in Aging, 11, 335–340.PubMedPubMedCentralGoogle Scholar
  61. Nikolaus, T., & Zeyfang, A. (2004). Pharmacological treatments for persistent non-malignant pain in older persons. Drugs Aging, 21, 19–41.PubMedCrossRefGoogle Scholar
  62. Ohayon, M. M., & Schatzberg, A. F. (2003). Using chronic pain to predict depressive morbidity in the general population. Archives of General Psychiatry, 60, 39–47.PubMedCrossRefGoogle Scholar
  63. Otis, J. A. D., & McGeeney, B. (2001). Managing pain in the elderly. Clinical Geriatrics, 9, 82–88.Google Scholar
  64. Oxman, M. N., Levin, M. J., Johnson, G. R., et al. (2005). A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. The New England Journal of Medicine, 352, 2271–2284.PubMedCrossRefGoogle Scholar
  65. Pergolizzi, J. V., Taylor, R., & Rafa, R. B. (2011). Extended-release formulations of tramadol in the treatment of chronic pain. Expert Opinion on Pharmacotherapy, 12, 1757–1768.PubMedCrossRefGoogle Scholar
  66. Pergolizzi, J. V., Raffa, R. B., Marcum, Z., Colucci, S., & Ripa, S. R. (2017). Safety of buprenorphine transdermal system in the management of pain in older adults. Postgraduate Medicine, 129, 92–101.PubMedCrossRefGoogle Scholar
  67. Pieper, M. J., van Dalen-Kik, A. H., Francke, A. L., et al. (2013). Interventions targeting pain or behavior in dementia: A systematic review. Ageing Research Reviews, 12, 1042–1055.PubMedCrossRefGoogle Scholar
  68. Pilgrim, A., & Robinson, S. (2015). An overview of appetite decline in older people. Nursing Older People, 27, 29–35.PubMedPubMedCentralCrossRefGoogle Scholar
  69. Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatment for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166, 514–530.PubMedCrossRefPubMedCentralGoogle Scholar
  70. Reid, M. C., Eccleston, C., & Pillimer, K. (2015). Management of chronic pain in older adults. BMJ, 350, h532.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Roy, M. K., Kuriakose, A. S., Varma, S. K., Jacob, L. A., & Beegum, N. J. (2017). A study on comparative efficacy and cost effectiveness of pregabalin and duloxtine used in diabetic neuropahtic pain. Diabetes & Metabolic Syndrome: Clinical research & Reviews, 11, 31–35.CrossRefGoogle Scholar
  72. Sandvik, R. K., Selbaek, G., Seifert, R., Aarsland, D., Ballard, C., Corbett, A., et al. (2014). Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: A cluster randomized trial. European Journal of Pain, 18, 1490–1500.PubMedCrossRefPubMedCentralGoogle Scholar
  73. Schwartz, S., Etropolski, M. S., Shapiro, D. Y., Rauschkolb, C., Vinik, A. I., Lange, B., Cooper, K., Van Hove, I., & Haeussler, J. (2015). A pooled analysis evaluating the efficacy and tolerability of tapentadol extended release for chronic, painful diabetic peripheral neuropathy. Clinical Drug Investigation, 35, 95–108.PubMedCrossRefPubMedCentralGoogle Scholar
  74. Singh, A., & Misra, N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry, 18, 51–55.CrossRefGoogle Scholar
  75. Spina, E., Santoro, V., & D’Arrigo, C. (2008). Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: An update. Clinical Therapeutics, 30, 1206–1227.PubMedCrossRefPubMedCentralGoogle Scholar
  76. Steiner, D., Munera, C., Hale, M., et al. (2011a). Efficacy and safety of buprenorphine transdermal system (BTDS) for chronic moderate to severe low back pain: A randomized, double-blind study. The Journal of Pain, 12, 1163–1173.PubMedCrossRefPubMedCentralGoogle Scholar
  77. Steiner, D. J., Sitar, S., Wen, W., et al. (2011b). Efficacy and safety of the seven day buprenorphine transdermal system in opioid-naive patients with moderate to severe chronic low back pain: An enriched, randomized, double-blind, placebo-controlled study. Journal of Pain and Symptom Management, 42, 903–917.PubMedCrossRefPubMedCentralGoogle Scholar
  78. Swope, R., & Adams, A. (2012). Prevention and treatment of orthostatic hypotension in the orthopedic patient population. Orthopedics, 35, 600–603.PubMedCrossRefPubMedCentralGoogle Scholar
  79. Tetreault, P., Mansour, A., Vachon-Presseau, E., et al. (2016). Brain connectivity predicts placebo response across chronic pain clinical trials. PLoS Biology, 14, 1–22.CrossRefGoogle Scholar
  80. Tsang, A., Von Korff, M., Lee, S., et al. (2008). Common persistent pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. The Journal of Pain, 9, 883–891.PubMedCrossRefGoogle Scholar
  81. Vorsanger, G., Xiang, J., Jordan, D., & Farrel, J. (2007). Post hoc analysis of a randomized, double-blind, placebo-controlled efficacy and tolerability study of tramadol extended release for the treatment of osteoarthritis pain in geriatric patients. Clinical Therapeutics, 29, 2520–2535.PubMedCrossRefGoogle Scholar
  82. Walhovd, K. B., Westlye, L. T., Amlien, I., et al. (2011). Consistent neuroanatomical age-related volume differences across multiple samples. Neurobiology of Aging, 32(5), 916–932.PubMedCrossRefGoogle Scholar
  83. Walitt, B., Urrutia, G., Nishishinya, M. B., Cantrell, S. E., & Hauser, W. (2015). Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database of Systematic Reviews, 6, 1–65.Google Scholar
  84. Warden, V., Hurley, A. C., & Volicer, L. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association, 4(1), 9–15.PubMedCrossRefPubMedCentralGoogle Scholar
  85. Weiner, D. K., Haggerty, C. L., Kritchevsky, S. B., et al. (2003). How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Medicine, 4, 311.PubMedCrossRefPubMedCentralGoogle Scholar
  86. Weiner, D. K., Rudy, T. E., Morone, N., Glick, R. M., & Kwoh, C. K. (2007). Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: An initial controlled clinical trial. Journal of the American Geriatrics Society, 55, 1541–1547.PubMedCrossRefPubMedCentralGoogle Scholar
  87. Weiner, D. K., Karp, J. F., Bernsetin, C. D., & Morone, N. E. (2013a). Pain medicine in older adults: How should it differ? In Treatment of chronic pain by integrative approaches (pp. 233–258). New York: Springer.Google Scholar
  88. Weiner, D. K., Moore, C. G., Morone, N. E., Lee, E. S., & Kwoh, C. K. (2013b). Efficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: A randomized controlled clinical trial. Clinical Therapeutics, 35, 1703–1720.PubMedCrossRefPubMedCentralGoogle Scholar
  89. Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., et al. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia-report of the multicenter criteria committee. Arthritis and Rheumatism, 33, 160–172.PubMedCrossRefGoogle Scholar
  90. Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., et al. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62, 600–610.PubMedCrossRefGoogle Scholar
  91. Wolfe, F., Clauw, D. J., Fitzchlarles, M. A., Goldenberg, D. L., et al. (2016). 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 46, 319–329.PubMedCrossRefGoogle Scholar
  92. Yezierski, R. P. (2012). The effects of age on pain sensitivity: Pre-clinical studies. Pain Medicine, 13, S27–S36.PubMedCrossRefGoogle Scholar
  93. Zakrzewska, J. M. (2010). Medical management of trigeminal neuropathic pains. Expert Opinion on Pharmacotherapy, 11, 1239–1254.PubMedCrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Geriatric MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Section of Geriatrics and Palliative MedicineUniversity of Chicago Department of MedicineChicagoUSA
  3. 3.Vitas HealthcareMiamiUSA
  4. 4.University of Central FloridaOrlandoUSA
  5. 5.Geriatric Research, Education & Clinical CenterVA Pittsburgh Healthcare SystemPittsburghUSA
  6. 6.Departments of Geriatric Medicine, Psychiatry, Anesthesiology, and Clinical and Translational Science InstituteUniversity of PittsburghPittsburghUSA

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