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Drug Safety
Published in: Drug Safety 6/2009

01-06-2009 | Review Article

Treatment of Chronic Non-Malignant Pain in the Elderly

Safety Considerations

Authors: Dr Jonathan Bruce Barber, Stephen J. Gibson

Published in: Drug Safety | Issue 6/2009

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Abstract

Non-malignant pain in the elderly is frequently under-treated, with physicians appearing to be uncertain concerning how best to achieve optimum management of this common problem in individual cases. The aim of this review is to provide a brief overview and discuss the variety of interacting factors that contribute to the continuing under-treatment of chronic non-malignant pain in the older population. The central objective is to encourage safer and more effective pain management in a population that is highly vulnerable to painful conditions and to the consequences of poorly treated pain.
Under-treatment of pain as experienced by the elderly is largely a consequence of uncertainties that arise within a complex environment that is underscored and exacerbated by the progressive and rapid aging of the global population. Uncertainties include the optimum management of pain in geriatric syndromes, frailty and dementia, and their impact on diagnosis, pain assessment and choices of treatment modalities. There is an inadequate evidence base for pharmacological interventions in older persons with respect to pharmacokinetic and pharmacodynamic changes that occur with aging. In this review, the prevalence of chronic pain and the incidence of adverse drug reactions are identified as factors that encourage conservatism in prescribing, as are major predictors of adverse drug reactions, i.e. aging, inappropriate combinations of medications and polypharmacy.
The major classes of analgesic drugs are summarized with reference to their mechanisms of action, analgesic properties and known adverse effects. Although all medications have associated risks, the use of analgesics in managing persistent pain in elderly people is widely supported and guided on the basis of clinical experience and consensus among specialists in geriatrics and pain management.
It is concluded that the absence of trial data, specific to the elderly, is substantially offset by information based on clinical experience and expert consensus statements. Used appropriately, analgesic and adjuvant treatments can and should be employed to relieve persistent pain in the expanding elderly population.
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Metadata
Title
Treatment of Chronic Non-Malignant Pain in the Elderly
Safety Considerations
Authors
Dr Jonathan Bruce Barber
Stephen J. Gibson
Publication date
01-06-2009
Publisher
Springer International Publishing
Published in
Drug Safety / Issue 6/2009
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI
https://doi.org/10.2165/00002018-200932060-00003

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