Pain in the Elderly

Molton IR, Terrill AL. Overview of persistent pain in older adults. Am Psychol. 2014;69:197–207. Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. This PDF, available from the CDC, illustrates the scope of the problem by exhibiting data on the increasing number of the elderly in our population, as well as the extent of disease and conditions afflicting them. Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179–87. Denard PJ, Holton KF, Miller J, Fink HA, Kado DM, Marshall LM. Back pain, neurogenic symptoms, and physical function in relation to spondylolisthesis among elderly men. Spine J. 2010;10:865–73. doi:10.1016/j.spinee.2010.07.004. Donald IP, Foy C. A longitudinal study of joint pain in older people. Rheumatology. 2004;43:1256–60. doi:10.1093/rheumatology/keh298. Mailis-Gagnon A, Nicholson K, Yegneswaran B, Zurowski M. Pain characteristics of adults 65 years of age and older referred to a tertiary care pain clinic. Pain Res Manag. 2008;13:389–94. Cleeland CS. Undertreatment of cancer pain in elderly patients. JAMA. 1998;279(23):1914–5. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common persistent pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9:883–91. doi:10.1016/j.jpain.2008.05.005. Kaye AD, Baluch A, Kaye R, Niaz RS, Kaye A, Liu H, et al. Geriatric pain management, pharmacological and nonpharmacological considerations. Psychol Neurosci. 2014;7(1):15–26. This recent article provides a comprehensive overview of chronic pain in the elderly population, including assessment and diagnosis, pathophysiological changes that occur with aging, comorbidities frequently co-occurring, as well as currently available pharmacologic and non-pharmacologic treatment modalities. Herr KA, Spratt K, Mobily PR, Richardson G. Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain. 2004;20(4):207–19. Gallasch CH, Alexandre NMC. The measurement of musculoskeletal pain intensity: a comparison of four methods. Rev Gaúcha Enferm. 2007;28(2):260–5. Gagliese L. Assessment of pain in the elderly. In: Turk DC, Melzack R, editors. Handbook of pain assessment. New York: Guilford Press; 2002. p. 119–33. Gagliese L, Melzack R. Age differences in the quality of chronic pain: a preliminary study. Pain Res Manag. 1997;2:157–62. American Geriatrics Panel on chronic pain in older persons. The management of chronic pain in older persons. J Am Geriatr Soc. 1998;46:635–51. Mark C. Bicket, Jianren Mao, Chronic pain in older adults, Anesthesiology Clinics, Volume 33, Issue 3, September 2015, Pages 577–590, ISSN 1932–2275. Sauver JLS, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013;88:56–67. Thielke S, Sale J, Reid MC. Aging: are these 4 pain myths complicating care? J Fam Pract. 2012;61:666–70. Theodoros Dimitroulas, Rui V. Duarte, Asis Behura, George D. Kitas, Jon H. Raphael, Neuropathic pain in osteoarthritis: a review of pathophysiological mechanisms and implications for treatment, Seminars in Arthritis and Rheumatism, Volume 44, Issue 2, October 2014, Pages 145–154, ISSN 0049–0172. Sharma L, Kapoor D, Issa S. Epidemiology of osteoarthritis: an update. Curr Opin Rheumatol. 2006;18:147–56. Schaible HG. Mechanisms of chronic pain in osteoarthritis. Curr Rheumatol Rep. 2012;14:549–56. Valdes AM, Suokas AK, Doherty SA, Jenkins W, Doherty M. History of knee surgery is associated with higher prevalence of neuropathic pain-like symptoms in patients with severe osteoarthritis of the knee. Semin Arthritis Rheum. 2014;43:588–92. Ohtori S, Orita S, Yamashita M, Ishikawa T, Ito T, Shigemura T, et al. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J. 2012;53:801–5. Duarte RV, Raphael JH, Dimitroulas T, Sparkes E, Southall JL, Ashford RL, et al. Osteoarthritis pain has a significant neuropathic component: an exploratory in vivo patient model. Rheumatol Int. 2014;34:315–20. Hochman JR, Elkayam J, Davis AM, Hawker GA, Gagliese L. Neuropathic pain symptoms on the modified pain DETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthr Cartil. 2013;21:1236–42. Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res. 2010;62:1019–23. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150–4. Veves A, Backonja M, Malik RA. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med. 2008;9:660–74. doi:10.1111/j.1526-4637.2007.00347.x. Katz JA. Diabetic and other peripheral neuropathies. In: Benzon HT, Raja S, Borsook D, Molloy RE, Strichartz GR, editors. Essentials of pain medicine and regional anesthesia. 2nd ed. New York: W.B. Saunders - Churchill Livingstone; 2005. p. 418–25. Smith AG, Ramachandran P, Tripp S, Singleton JR. Epidermal nerve innervation in impaired glucosetolerance and diabetes-associated neuropathy. Neurology. 2001;57:1701–4. Pickering G. Antiepileptics for post-herpetic neuralgia in the elderly: current and future prospects. Drugs Aging. 2014;31(9):653–60. Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Soc Med. 1965;58:9–20. Dworkin RH, Gnann Jr JW, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain. 2008;9(11):S37–44. Johnson RW. Zoster-associated pain: what is known, who is at risk and how can it be managed? Herpes. 2007;14 Suppl 2:30–4. Patel KV, Guralnik JM, Dansie EJ, Turk DC. Prevalence and impact of pain among older adults in the United States: Findings from the 2011 National Health and Aging Trends Study. Pain. 2013;154(12). doi:10.1016/j.pain.2013.07.029. Dunn KM et al. Low back pain across the life course. Best Pract Res Clin Rheumatol. 2013;27(5):591–600. Dionne CE et al. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing. 2006;35(3):229–34. Golob AL, Wipf JE. Low back pain. Med Clin N Am. 2014;98(3):405–28. Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg Am. 1990;72:403–8. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:69–73. Tracy B, Sean MR. Pain management in older adults. Clin Ther. 2013;35(11):1659–68. Schwartz JB. The current state of knowledge on age, sex, and their interactions on clinical pharmacology. Clin Pharmacol Ther. 2007;82(1):87–96. Miller RA. The biology of aging and longevity. In: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S, editors. Hazzard’s geriatric medicine and gerontology. 6th ed. New York: McGraw Hill; 2009. Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol. 1976;31:155–63. Tumer N, Scarpace PJ, Lowenthal DT. Geriatric pharmacology: basic and clinical considerations. Annu Rev Pharmacol Toxicol. 1992;32:271–302. Davies DF, Shock NW. Age changes in glomerular filtration rate, effect of venal plasma flow, and tubular excretory capacity in adult males. J Clin Invest. 1950;29(5):496–507. Malec M, Shega JW. Pain management in the elderly. Med Clin N Am. 2015;99(2):337–50. Avorn J, Gurwitz JH, Rochon P. Principles of pharmacology. In: Cassel CK, Leipzig RM, Cohen HJ, Larson EB, Meier DE, Capello CF, editors. Geriatric medicine: an evidence-based approach. 4th ed. New York: Springer; 2003. p. 65–77. Paladini A, Fusco M, Coaccioli S, Skaper SD, Varrassi G. Chronic pain in the elderly: the case for new therapeutic strategies. Pain Phys. 2015;18(5):E863–76. The information found in this article reveals how far we have to go in our understanding of pain mechanisms, solidifying the case for continued research and development of new techniques to combat pain syndromes. Tseng MT, Chiang MC, Yazhuo K, Chao CC, Tseng WY, Hsieh ST. Effect of aging on the cerebral processing of thermal pain in the human brain. Pain. 2013;154:2120–9. Lautenbacher S, Kunz M, Strate P, Nielsen J, Arendt-Nielsen L. Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain. 2005;115:410–8. Lautenbacher S. Experimental approaches in the study of pain in the elderly. Pain Med. 2012;13:S44–50. Morrissey MB, Viola D, Shi Q. Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work. J Soc Work End Life Palliat Care. 2014;10:8–33. Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain. 2004;20:227–39. Washington LL, Gibson SJ, Helme RD. Age-related differences in the endogenous analgesic response to repeated cold water immersion in human volunteers. Pain. 2000;89:89–96. Edwards RR, Fillingim RB, Ness TJ. Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults. Pain. 2003;101:155–65. Riley 3rd JL, King CD, Wong F, Fillingim RB, Mauderli AP. Lack of endogenous modulation and reduced decay of prolonged heat pain in older adults. Pain. 2010;150:153–60. Naugle KM, Cruz-Almeida Y, Fillingim RB, Riley 3rd JL. Offset analgesia is reduced in older adults. Pain. 2013;154:2381–7. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50 Suppl 6:S205–24. Weiner DK, Haggerty CL, Kritchvesky SB, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311–20. Bosley BN, Weiner DK, Rudy TE, et al. Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. J Am Geriatr Soc. 2004;52:247–51. Shega JW, Dale W, Andrews M, et al. Persistent pain and frailty: a case for pain homeostenosis? J Am Geriatr Soc. 2012;60(1):113–7. Shega JW, Andrew M, Lau D, et al. The relationship between persistent pain and 5-year mortality: a population-based, prospective cohort study. J Am Geriatr Soc. 2013;61(12):2135–40. Stjernsward J. WHO cancer pain relief programme. Cancer Surv. 1988;7:195–208. Graham GG, Davies MJ, Day RO, et al. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21:201–32. Larson AM, Polson J, Fontana RJ, et al. Acute Liver Failure Study Group. Acetaminophen-induced acute liver failure: results of a US multicenter prospective study. Hepatology. 2005;42(6):1364–72. U.S Food and Drug Administration. FDA Drug Safety Communication: prescription acetaminophen products to be limited to 325 mg per dosage unit; boxed warning will highlight potential for severe liver failure. January 13, 2011. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm239821.htm. Accessed Oct 2015. American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Patients. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57:1331–46. Barkin RL, Beckerman M, Blum SL, et al. Should nonsteroidal anti-inflammatory drugs (NSAIDs) be prescribed to the older adult? Drugs Aging. 2010;27(10):775–89. Reid MC, Shengelia R, Parker SJ. Pharmacologic management of osteoarthritis-related pain in older adults: a review shows that many drug therapies provide small-to- modest pain relief. HSS J. 2012;8:159–64. Goldstein NE, Morrison RS. Treatment of pain in older patients. Crit Rev Oncol Hematol. 2005;54:157–64. Reddy A, Yennurajalingam S, Pulivarthi K, et al. Frequency, outcome, and predictors of success within 6 weeks of an opioid rotation among outpatients with cancer receiving strong opioids. Oncologist. 2013;18:212–20. Gupta DK, Avram MJ. Rational opioid dosing in the elderly: dose and dosing intervals when initiating opioid therapy. Clin Pharmacol Ther. 2012;91(2):339–43. McKeown JL. Pain management issues for the geriatric surgical patient. Anesthesiol Clin. 2015;33(3):563–76. doi:10.1016/j.anclin.2015.05.010. Brummel-Smith K. Rehabilitation. In: Cassel CK, Cohen HJ, Larson EB, editors. Geriatric medicine. 3rd ed. New York: Springer; 1997. p. 211–26.