Acute pain in the elderly

Abstract

Physiological changes that occur with age affect the pharmacokinetics and pharmacodynamics of drugs used in acute pain management. Elderly patients are often reluctant to complain of pain and seek treatment and may sometimes be unable to express pain due to impaired cognition or language. Evidence suggests the elderly as a group that receive inadequate analgesia and are often in pain. Health care professionals are often reluctant to administer sufficient analgesia due to fear of encouraging addiction or inducing side effects. The approach to pain management in this group should follow the World Health Organization (WHO) analgesic ladder with close monitoring for potential side effects and with escalation of treatment till sufficient analgesia is achieved. Choice of drugs and the route of administration should be tailored to the individual patient and should consider the nature of their pain and any disability or co-morbidity that will affect their response to the chosen agent. Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with extreme caution, monitoring for potential gastrointestinal (GI) and renal side effects and long-term use should be avoided if possible. Opioids are effective analgesics and should not be denied to the elderly but their use should be monitored carefully and side effects such as nausea and constipation anticipated and treated.