[Management strategies for the treatment of non malignant chronic pain in the elderly].
Chronic pain has a growing incidence with age. In the elderly, the most frequent etiologies of pain are musculoskeletal diseases, neuropathic pain and cancer. Pain management in older patients requires a comprehensive assessment, adapted to the patient's cognitive functioning, using specific tools, and taking into account the daily life activities and autonomy. Management includes drugs, especially paracetamol and level 2 and 3 opioids. Non steroidal anti-inflammatory drugs (NSAIDs) should be avoided, including COX-2 inhibitors. Drugs are to be prescribed regularly, pre-emptively, and via oral route. Immediate release drugs should be selected, and a slow increase of dosages. Local treatments should be preferred: local injections, topical application and physiotherapy. Rehabilitation, pool-therapy, crenotherapy may be proposed. In conclusion, chronic pain management in elderly patients does not importantly differ from that in younger patients. Specificities are more related to the assessment of pain and to the drugs side effects rather than to the type of drugs.
Perrot
Serge
S
Service de médecine interne, Hôtel Dieu, Place du Parvis Notre Dame, Paris. serge.perrot@htd.aphp.fr
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen