title: Management of pain in older adults.
abstract: The elderly are often untreated or undertreated for pain. Barriers to effective management include challenges to proper assessment of pain; underreporting on the part of patients; atypical manifestations of pain in the elderly; a need for increased appreciation of the pharmacokinetic and pharmacodynamic changes of aging; and misconceptions about tolerance and addiction to opioids. Physicians can effectively manage pain in the elderly by understanding different types of pain (nociceptive and neuropathic), and appropriate use of nonopioid, opioid, and adjuvant medications. Opioids have become more widely accepted for treating older adults who have persistent pain, but their use requires physicians have an understanding of prevention and management of side effects, opioid titration and withdrawal, and careful monitoring. Placebo use is unwarranted and unethical. Nonpharmacologic approaches to pain management are essential and include osteopathic manipulative treatment, cognitive behavioral therapy, exercise, and spiritual interventions. The holistic and interdisciplinary approach of osteopathic medicine offers an approach that can optimize effective pain management in older adults.
authors.affiliation: Department of Medicine, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Stratford, New Jersey, 08084-1354, USA. cavalita@umdnj.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Cavalieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017028:Caregivers / Q000193:education; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies / Q000379:methods*; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D010021:Osteopathic Medicine / Q000379:methods; D010146:Pain / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods* / Q000523:psychology; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011788:Quality of Life / Q000523:psychology; D018570:Risk Assessment; D018434:Sickness Impact Profile; D029181:Spirituality
chemical_list: D000700:Analgesics