Chronic Pain Management in Older Adults

Main Article Content

Sirasa Ruangritchankul
Orapitchaya Krairit

Abstract

Chronic pain in the elderly usually has negative impacts on physical and psychological status, therefore, early diagnosis and treatment should be performed. The principle of chronic pain management is assessment of pathophysiology which leads to different choices of treatment. Furthermore, chronic pain management in the elderly should be combined nonpharmacological such as cognitive-behavioral therapy and pharmacological treatment in order to increase efficacy of pain control. Pharmacological management for chronic pain is composed of 3 categories including nonopioid analgesics, opioid analgesics, and adjuvant medications. The strategies of pharmacological treatment in the elderly are consideration of start with a low dose and slow titration. Moreover, physicians and pharmacists should be aware of drug-drug interactions, drug-disease interactions, as well as adverse drug reactions and events during treatment.


 

Article Details

How to Cite
1.
Ruangritchankul S, Krairit O. Chronic Pain Management in Older Adults. Rama Med J [Internet]. 2019 Jun. 28 [cited 2024 Mar. 29];42(2):63-78. Available from: https://he02.tci-thaijo.org/index.php/ramajournal/article/view/136135
Section
Review Articles

References

Ruangritchankul S, Krairit O. Chronic pain assessment in the elderly. Rama Med J. 2018;41(3):92-99. doi:10.14456/rmj.2018.24.

Ferrell BR, Rhiner M, Ferrell BA. Development and implementation of a pain education program. Cancer. 1993;72(11 Suppl):3426-3432.

Keefe FJ, Beaupre PM, Weiner DK, Siegler IC. Pain in older adults: A cognitive-behavioral perspective. In: Ferrell BR, Ferrell BA, eds. Pain in the Elderly. Seattle, Wash: IASP Press; 1996:11-19.

Abdulla A, Adams N, Bone M, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42 (Suppl 1):i1-i57. doi:10.1093/ageing/afs200.

AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6):S205-S224.

Cavalieri TA. Pain management in the elderly. J Am Osteopath Assoc. 2002;102(9):481-485.

Berman BM, Singh BB, Lao L, et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology (Oxford). 1999;38(4):346-354.

Gibson SJ. IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother. 2007;7(6):627-635. doi:10.1586/14737175.7.6.627.

Jubb RW, Piva S, Beinat L, Dacre J, Gishen P. A one-year, randomised, placebo (saline) controlled clinical trial of 500-730 kDa sodium hyaluronate (Hyalgan) on the radiological change in osteoarthritis of the knee. Int J Clin Pract. 2003;57(6):467-474.

Neustadt DH. Intra-articular injections for osteoarthritis of the knee. Cleve Clin J Med. 2006;73(10):897-898, 901-904, 906-911.

Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179-187.

The management of chronic pain in older persons. AGS panel on chronic pain in older persons. American Geriatrics Society. Geriatrics. 1998;53(Suppl 3):S8-S24.

Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;38(8): 843-853. doi:10.1016/S0531-5565(03)00133-5.

ElDesoky ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther. 2007;14(5):488-498. doi:10.1097/01.mjt.0000183719.84390.4d.

Ruangritchankul S. Polypharmacy in the elderly. Rama Med J. 2018; 41(1):95-104. doi:10.14456/rmj.2018.9.

Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly. Drugs Aging. 2003;20(1):23-57. doi:10.2165/00002512-200320010-00003.

Sela-Katz P, Rabinowitz I, Shugaev I, Shigorina G. Basic knowledge of the medication regimen correlates with performance on cognitive function tests and diagnosis of dementia in elderly patients referred to a geriatric assessment unit. Gerontology. 2010;56(5):491-495. doi:10.1159/000304738.

Pergolizzi J, Boger RH, Budd K, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8(4):287-313. doi:10.1111/j.1533-2500.2008.00204.x.

World Health Organization. Cancer pain relief: with a guide to opioid availability. 2nd ed. Geneva, Switzerland: World Health Organization; 1996.

Stucki G, Johannesson M, Liang MH. Use of misoprostol in the elderly: is the expense justified? Drugs Aging. 1996;8(2):84-88. doi:10.2165/00002512-199608020-00002.

FitzGerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase-2. N Engl J Med. 2001;345(6):433-442. doi:10.1056/NEJM200108093450607.

Lipsky LP, Abramson SB, Crofford L, Dubois RN, Simon LS, van de Putte LB. The classification of cyclooxygenase inhibitors. J Rheumatol. 1998;25(12):2298-2303.

Brooks P, Emery P, Evans JF, et al. Interpreting the clinical significance of the differential inhibition of cyclooxygenase-1 and cyclooxygenase-2. Rheumatology (Oxford). 1999;38(8):779-788.

American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331-1346. doi: 10.1111/j.1532-5415.2009.02376.x.

Ackerman SJ, Knight T, Schein J, Carter C, Staats P. Risk of constipation in patients prescribed fentanyl transdermal system or oxycodone hydrochloride controlled-release in a California Medicaid population. Consult Pharm. 2004;19(2):118-132.

Barber JB, Gibson SJ. Treatment of chronic non-malignant pain in the elderly: safety considerations. Drug Saf. 2009;32(6):457-474. doi:10.2165/00002018-200932060-00003.

Chanvej L. Principle and Pharmacological Treatment of Pain Management in Older Adults Conference, Faculty of Medicine, Prince of Songkla University; May 6 - 28, 2004; Songkhla, Thailand.

Gloth FM, 3rd. Pain management in older adults: prevention and treatment. J Am Geriatr Soc. 2001;49(2):188-199. doi:10.1046/j.1532-5415.2001.49041.x.

Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113-e88. doi:10.1111/j.1468-1331.2010.02999.x.