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.
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References
Ozyalcin NS. Minimal invasive treatment modalities for geriatric pain management. Agri. 2004;16:26–36.
Freedman GM. Chronic pain. Clinical management of common causes of geriatric pain. Geriatrics. 2002;57:36–41.
Frymoyer JW, Cats-Baril WL. An overview of the incidence and costs of low back pain. Orthop Clin N Am. 1991;22:263–71.
Shamie AN. Lumbar spinal stenosis: the growing epidemic. AAOS Now. 2011;5(5):9–11.
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.
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.
Snyder DL, Doggartt D, Turkelson C. Treatment of degenerative lumbar spinal stenosis. Am Fam Physician. 2004;70:517–20.
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.
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.
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.
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.
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.
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.
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.
Lievre JA, Bloch-Michel H, Pean G. L’hydrocortisone en injection locale. Revue du Rhumatisme et des Maladies Osteo-articulares. 1953;20:310–1.
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.
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.
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.
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.
Helbig T, Lee CK. The lumbar facet syndrome. Spine (Phila Pa 1976). 1988;13(1):61–4.
Cohen SP, Huang JH, Brummett C. Facet joint pain—advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101–16.
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.
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.
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.
Cohen SP, Raja SN. Pathogenesis, diagnosis and treatment of lumbar zygopophyseal (facet) joint pain. Anesthesiology. 2007;106:591–614.
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.
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.
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.
van Eerd M, Patijn J, Lataster A, et al. Cervical facet pain. Pain Pract. 2010;10:113–23.
Ward A, Watson J, Wood P, et al. Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae. Rheumatology (Oxford). 2002;41(1):68–71.
Walker J. The sacroiliac joint: a critical review. Phys Ther. 1992;72:903–16.
Bernard TN, Cassidy JD. The sacroiliac syndrome. In: Frymoyer JW, editor. Pathophysiology, diagnosis and management. New York: Raven; 1991. p. 2107–30.
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.
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.
Slipman CW, Jackson HB, Lipetz JS, et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil. 2000;81(3):334–8.
Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101:1440–53.
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.
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.
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.
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.
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.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.
Bajaj S, Saag KG. Osteoporosis: evaluation and treatment. Curr Womens Health Rep. 2003;3(5):418–24.
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.
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.
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.
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.
Peh WCG, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology. 2002;223:121–6.
Mehbod A, Aunoble S, Le Huec JC. Vertebroplasty for osteoporotic spine fracture: prevention and treatment. Eur Spine J. 2003;12(Suppl 2):S155–62.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(699):971–9.
Deer T, Masone R. Selection of spinal cord stimulation candidates for the treatment of chronic pain. Pain Med. 2008;9(S1):S82–92.
Mekhail N, Aeshbach A, Stanton-Hicks M. Cost benefit analysis of neurostimulation for chronic pain. Clin J Pain. 2004;20(6):462–8.
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.
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.
Pert CB, Snyder SH. Opiate receptor: demonstration in nervous tissue. Science. 1973;179(77):1011–4.
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.
Krames ES. Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manag. 1993;8(1):36–46.
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.
Krames E. Clinical realities and economic considerations: patient selection in intrathecal therapy. J Pain Symptom Manag. 1997;14(3S):S3–S13.
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.
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.
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.
Belverud S, Mogilner A, Schulder M. Intrathecal pumps. Neurotherapeutics. 2008;5(1):114–22.
Cohen SP, Dragovich A. Intrathecal analgesia. Anesthesiol Clin. 2007;25(4):863–82. viii
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.
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.
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.
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.
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.
Modawal A, Ferrer M, Choi HK, Castle JA. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005;54:758–67.
Aggarwal A, Sempowski I. Hyaluronic acid injections for knee osteoarthritis. Systematic review of the literature. Can Fam Physician. 2004;50:249–56.
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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
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