Question

I would like information on pain assessment and treatment in the elderly.

Answer

Pain is one of the most common symptoms doctors treat, especially if they manage older people. If possible, it is best to treat the cause of the pain, but if this is not possible, then a multi-dimensional perspective is almost always needed for treating persistent pain. For example, pain may be physical or psychological.

The first point in assessment is to decide whether the pain is acute or chronic. Then assess mood, and finally the effect of pain on activity and social function. Examination of the patient, together with the history, will indicate the nature of the pain and possibly the cause, such as for example neurological or bone.

Medication for pain is usually titrated upwards, both in dose and in strength of analgesic. Persistent pain is better treated with regular medication, to try and prevent pain rather than to give analgesics as pain occurs, because the former process causes better analgesia, less anxiety and usually a lower total analgesic intake. The type of analgesic used depends on the patient, the circumstances and the cause of the pain, but can range from simple analgesics such as aspirin and paracetamol (acetaminophen) to opioid analgesia.

Psychological strategies play a major part in treating chronic pain, and physical strategies such as exercise, posture, splinting and so forth are important. Electrotherapy (Transcutaneous Electrical Nerve Stimulation, or TENS) is portable, safe and can be self-administered. There is no doubt that it provides great relief to some individuals and therefore is probably worth a try.

Finally there may be referral to a multidisciplinary pain clinic which deals particularly with pain and its management.