Pharmacologic management of pain in older patients

Based on changes in physiology, a higher percentage of medical comorbidities, and a higher incidence of adverse events as we age, treating older adults with pain is a more complex issue as compared to treating younger persons. Each of these factors needs to be considered when designing a treatment plan uniquely tailored to an individual. Changes in liver and kidney function, in addition to the risk for GI and cardiovascular events, may determine treatment choices to a certain extent. While a short course of treatment for an acute issue may not differ greatly from younger patients, except in dosages of medications used, persistent pain in older patients demands careful assessment and an ongoing monitoring program to determine the efficacy of the interventions being used. In addition to determining the level of analgesia being produced, adverse events also need to be predicted and prevented if at all possible to allow patients to continue on their medication regimens. By selecting the appropriate combination of medications and nonpharmacologic interventions, clinicians can help manage their patients' pain and improve the quality of their lives at any age.