title: Pain management in older adults.
abstract: BACKGROUND
  Chronic pain is prevalent among older adults but is underrecognized and undertreated. The approach to pain assessment and management in older adults requires an understanding of the physiology of aging, validated assessment tools, and common pain presentations among older adults.
  
  
  OBJECTIVE
  To identify the overall principles of pain management in older adults with a specific focus on common painful conditions and approaches to pharmacologic treatment.
  
  
  METHODS
  We searched PubMed for common pain presentations in older adults with heart failure, end-stage renal disease, dementia, frailty, and cancer. We also reviewed guidelines for pain management. Our review encompassed 2 guidelines, 10 original studies, and 22 review articles published from 2000 to the present. This review does not discuss nonpharmacologic treatments of pain.
  
  
  RESULTS
  Clinical guidelines support the use of opioids in persistent nonmalignant pain. Opioids should be used in patients with moderate or severe pain or pain not otherwise controlled but with careful attention to potential toxic effects and half-life. In addition, clinical practice guidelines recommend use of oral nonsteroidal anti-inflammatory drugs with extreme caution and for defined, limited periods.
  
  
  CONCLUSIONS
  An understanding of the basics of pain pathophysiology, assessment, pharmacologic management, and a familiarity with common pain presentations will allow clinicians to effectively manage pain for older adults.
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: bridget.tracy@mssm.edu.
authors.forename: Bridget
authors.initials: B
authors.lastname: Tracy
authors.forename: R
authors.initials: R
authors.lastname: Sean Morrison
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000503:physiopathology; D003704:Dementia / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology; D009437:Neuralgia / Q000188:drug therapy* / Q000503:physiopathology; D059408:Pain Management / Q000379:methods*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: elderly patients; geriatrics; pain