Skip to main content
SpringerLink
Log in

Managing Chronic Pain in Older Adults

  • Chapter
  • First Online:
Treating Comorbid Opioid Use Disorder in Chronic Pain

  • 917 Accesses

Abstract

Older patients account for the largest group suffering from chronic pain and multiple comorbidities. Pain management in older patients must consider this population’s changing sensitivities to drugs and common issues with polypharmacy. Undertreated or overmedicated pain is associated with functional limitations and increased risk of depression. Improvements in pain, mood, and functioning among older patients depend on coordinated and complementary care. In the following chapter, we review recent research on pain management, important aspects in the assessment of chronic pain in older patients, and treatment strategies that incorporate both pharmacological and nonpharmacological interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zanocchi M, et al. Chronic pain in a sample of nursing home resident: prevalence, characteristics, influence of quality of life (QoL). Arch Gerontol Geriatr. 2008;47:121–8.

    Article  PubMed  Google Scholar 

  2. López-Lopez A, González JL, et al. Pain and symptoms of depression in older adults living in community and in nursing homes: the role of activity restriction as a potential mediator and moderator. Int Psychogeriatr. 2014;26(10):1679–91.

    Article  PubMed  Google Scholar 

  3. Herr K. Pain assessment strategies in older patients. J Pain. 2011;12(3):S3–13.

    Article  PubMed  Google Scholar 

  4. Monti DA, Kunkel EJS. Management of chronic pain among elderly patients. Psychiatr Serv. 1998;49(12):1537–9.

    Article  CAS  PubMed  Google Scholar 

  5. Kozma CM, Provenzano DA, Slaton TL, et al. Complexity of pain management among patients. J Manage Care Spec Pharm. 2014;20(5):455–66.

    Google Scholar 

  6. Lapane KL, et al. The association between pain and measures of well-being among nursing home residents. J Am Med Dir Assoc. 2012;13:344–9.

    Article  PubMed  Google Scholar 

  7. Yong HH. Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance and functional interference in chronic pain patients? Eur J Pain. 2006;10(5):399–407.

    Article  PubMed  Google Scholar 

  8. Turner JA, Ersek M, Kemp C. Self-efficacy for managing pain is associated with disability, depression, and pain coping among retirement community residents with chronic pain. J Pain. 2005;6(7):471–9.

    Article  PubMed  Google Scholar 

  9. Coupland J, Coupland N. “Old age doesn’t come alone”: discursive representations of health-in-aging in geriatric medicine. Int J Aging Hum Dev. 1994;39:81–95.

    Article  CAS  PubMed  Google Scholar 

  10. Ickowicz E, American Geriatric Society Panel on the Pharmacological Management of Persistent Pain in Older Persons, et al. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57:1331–46.

    Article  Google Scholar 

  11. Schatzberg A, Cole J, DeBattista C, editors. Pharmacotherapy in special situations manual of clinical psychopharmacology. 7th ed. Washington, DC: APA; 2010. p. 619.

    Google Scholar 

  12. Steffens DC, Blazer DG, Thakur ME, editors. Chapter 2: Physiological and clinical considerations of geriatric patient care—considerations in geriatric prescribing. Textbook of geriatric psychiatry. 5th ed. Arlington: APA; 2015.

    Google Scholar 

  13. Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging. 2012;29(5):359–76.

    Article  CAS  PubMed  Google Scholar 

  14. Chapman IM, MacIntosh CG, Morley JE, Horowitz M. The anorexia of ageing. Biogerontology. 2012;2(1-2):67–71.

    Google Scholar 

  15. Schmader K. Postherpetic neuralgia in immunocompetent elderly people. Vaccine. 1998;16(18):1768–70.

    Article  CAS  PubMed  Google Scholar 

  16. Schatzberg A, Cole J, DeBattista C, editors. Pharmacotherapy in special situations manual of clinical psychopharmacology. 7th ed. Washington, DC: APA; 2010. p. 635.

    Google Scholar 

  17. Koyyalagunta D, Bruera E, Aigner C, Nusrat H, Driver L, Novy D. Risk stratification of opioid misuse among patients with cancer pain using the SOAPP-SF. Pain Med. 2013;14(5):667–75.

    Article  PubMed  Google Scholar 

  18. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Weiner D, Karp J, Bernstein C, Morone N. Pain medicine in older adults: how should it differ? In: Der T, Ray A, Gordin V, et al., editors. Comprehensive treatment of chronic pain by medical, interventional and behavioral approaches. New York: Springer; 2012. p. 977.

    Google Scholar 

  20. Brown RT, Zuelsdorff M, Fleming M. Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain. J Opioid Manag. 2006;2(3):137–46.

    PubMed  Google Scholar 

  21. Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. CDC. National Center for Health Statistics Data Brief No. 42,. http://www.cdc.gov/nchs/data/databriefs/db42.htm. Accessed March 31, 2015.

  22. Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):1–9.

    Article  Google Scholar 

  23. Marcum ZA, Amuan ME, Hanlon JT, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older Veterans. J Am Geriatr Soc. 2012;60:34–41.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Davidoff AJ, Miller GE, Sarpong EM, Yang E, Brandt N, Fick DM. Prevalence of potentially inappropriate medication use in older adults using the 2012 Beers criteria. J Am Geriatr Soc. 2015;63(3):486–500.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Frankenthal D, Lerman Y, Kalendaryev E, Lerman Y. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. J Am Geriatr Soc. 2014;62(9):1658–65.

    Article  PubMed  Google Scholar 

  26. Fine PG. Chronic pain management in older adults: special considerations. J Pain Symptom Manage. 2009;38(2 Suppl):S4–14.

    Article  PubMed  Google Scholar 

  27. Meltzer EC, Rybin D, Saitz R, Samet JH, Schwartz SL, Butler SF, et al. Identifying prescription opioid use disorder in primary care: diagnostic characteristics of the Current Opioid Misuse Measure (COMM). Pain. 2011;152(2):397–402.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6:432–42.

    Article  PubMed  Google Scholar 

  29. Butler SF, Budman SH, Fernandez KC, et al. Validation of the current opioid misuse measure. Pain. 2007;130:144–5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jones T, Lookatch S, Grant P, McIntyre J, Moore T. Further validation of an opioid risk assessment tool: the Brief Risk Interview. J Opioid Manag. 2014;10(5):353–64.

    Article  PubMed  Google Scholar 

  31. Moore TM, Jones T, Browder JH, Daffron S, Passik SD. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009;10(8):1426–33.

    Article  PubMed  Google Scholar 

  32. Chou R, Fanciullo GJ, Fine PG, Miaskowski C, Passik SD, Portenoy RK. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009;10(2):131–46.

    Article  CAS  PubMed  Google Scholar 

  33. Pesonen A, Kauppila T, Tarkkila P, Sutela A, Niinisto L, Rosenberg PH. Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients. Acta Anaesthesiol Scand. 2009;53(5):657–64.

    Article  CAS  PubMed  Google Scholar 

  34. Apinis C, Tousignant M, Arcand M, Tousignant-Laflamme Y. Can adding a standardized observational tool to interdisciplinary evaluation enhance the detection of pain in older adults with cognitive impairment? Pain Med. 2014;15(1):32–41.

    Article  PubMed  Google Scholar 

  35. Horgas A, Mille L. Pain assessment in people with dementia. Am J Nurs. 2008;108(7):62–70; quiz 71.

    Article  PubMed  Google Scholar 

  36. Resnick NM, Marcantonio RO. How should clinical care of the aged differ? Lancet. 1997;350:1157.

    Article  CAS  PubMed  Google Scholar 

  37. Ozturk A, Simsek TT, Yumin ET, Sertel M, Yumin M. The relationship between physical, functional capacity, and quality of life (QoL) among elderly people with a chronic disease. Arch Gerontol Geriatr. 2011;53(3):278–83.

    Article  PubMed  Google Scholar 

  38. Panel AGS. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50:S205–24.

    Article  Google Scholar 

  39. Kahan M, Mailis-Gagnon A, Wilson L, Srivastava A. Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Clinical summary for family physicians. Part 1: general population. Can Fam Physician. 2011;57:1257–66.

    PubMed  PubMed Central  Google Scholar 

  40. Weiner DK. Office management of chronic pain in the elderly. Am J Med. 2007;120:306.

    Article  PubMed  Google Scholar 

  41. Weiner DK, Herr K. Comprehensive assessment and interdisciplinary treatment planning: an integrative overview. In: Weiner DK, Herr K, Rudy T, editors. Persistent pain in older adults: an interdisciplinary guide for treatment. New York: Springer; 2002. p. 18.

    Google Scholar 

  42. Dobscha SK, Morasco BJ, Dukart JP, Macey T, Deyo RA. Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain. Clin J Pain. 2013;29(2):102–8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Windmill J, Fisher E, Eccleston C, Derry S, Stannard C, Knaggs R, Moore RA. Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane Database Syst Rev. 2013;9:CD010323.

    PubMed  Google Scholar 

  44. Wallace LS, Wexler RK, McDougle L, Miser WF, Haddox JD. Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain. J Pain Res. 2014;7:291–9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Benyamen R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician. 2008;11(2):S105–20.

    Google Scholar 

  46. Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A. Canadian guideline for safe and effective use of opioids for chronic noncancer pain clinical summary for family physicians. Part 2: special populations. Can Fam Physician. 2011;57:1269–76.

    PubMed  PubMed Central  Google Scholar 

  47. Deyo RA, Smith DH, Johnson ES, Donovan M, Tillotson CJ, Yang X, Petrik AF, Dobscha SK. Opioids for back pain patients: primary care prescribing patterns and use of services. J Am Board Fam Med. 2011;24(6):717–27.

    Article  PubMed  Google Scholar 

  48. Dobscha SK, Morasco BJ, Kovas AE, Peters DM, Hart K, McFarland BH. Short-term variability in outpatient pain intensity scores in a national sample of older veterans with chronic pain. Pain Med. 2014;16(5):855–65.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gloth III FM. Pharmacological management of persistent pain in older persons: focus on opioids and nonopioids. J Pain. 2011;12(3):S14–20.

    Article  CAS  PubMed  Google Scholar 

  50. Miotto K, Kaufman A, Kong A, Jun G, Schwartz J. Managing co-occurring substance use and pain disorders. Psychiatr Clin North Am. 2012;35:393–409.

    Article  PubMed  Google Scholar 

  51. Cheatle M, Comer D, Wunsch M, Skoufasol A, Reddy Y. Treating pain in addicted patients: recommendations from an Expert Panel. Popul Health Manag. 2014;17(2):79–89.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6(2):107–12.

    Article  PubMed  Google Scholar 

  53. Cook AJ. Cognitive-behavioral pain management for elderly nursing home residents. J Gerontol B Psychol Sci Soc Sci. 1998;53:51–9.

    Article  Google Scholar 

  54. Laforest S, Nour K, Gignac M, Gauvin L, Parisien M, Poirier M. Short-term effects of a self-management intervention on health status of housebound older adults with arthritis. J Appl Gerontol. 2008;27:539–67.

    Article  Google Scholar 

  55. Bruel S, Apkarian AV, Ballantyne JC, Berger A, Borsook D, et al. Personalized medicine and opioid analgesic prescribing for chronic pain: opportunities and challenges. J Pain. 2013;14(2):103–13.

    Article  Google Scholar 

  56. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, Knaggs R, Martin D, Sampson L, Schofield P, British Geriatric Society. Guidance on the management of pain in older people. Age Ageing. 2013;42:i1–i57.

    Article  PubMed  Google Scholar 

  57. Finnerup NB, Attal N, Haroutounian S, Mcnicol E, Baron R, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and metaanalysis. Lancet Neurol. 2015;162–73.

    Google Scholar 

  58. O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. 2009;122:S22–32.

    Article  PubMed  Google Scholar 

  59. Huang AR, Mallet L. Prescribing opioids in older people. Maturitas. 2013;74(2):123–9.

    Article  PubMed  Google Scholar 

  60. Vissers KC, Besse K, Hans G, Devulder J, Morlion B. Opioid rotation in the management of chronic pain: where is the evidence? Pain Pract. 2010;10(2):85–93.

    Article  CAS  PubMed  Google Scholar 

  61. Knotova H, Fine PG, Protenoy RK. Opioid rotation: the science and the limitations of the equianalgesic dose table. J Pain Symptom Manage. 2009;38:426–39.

    Article  Google Scholar 

  62. http://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/CL001

  63. http://www.who.int/cancer/palliative/painladder/en/

  64. Von Korff MR. Long-term use of opioids for complex chronic pain. Best Pract Res Clin Rheumatol. 2013;27(5):663–72.

    Article  Google Scholar 

  65. Fine PG, Protenoy RK. Establishing”best practices” for opioid rotation, conclusions of an expert panel. J Pain Symptom Manage. 2009;38:418–42.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mental Health and Neurosciences Division, Portland VA Health Care System, 3710 SW US Veterans Hospital Rd., V3CRS, Portland, OR, 97239, USA

    Michael J. Yao M.D., M.P.H.

  2. Department of Psychiatry, Oregon Health and Science University, 3818 SW Sam Jackson Park Rd., UHN 80, Portland, OR, 97239, USA

    Katherine A. Tacker M.D.

Authors
  1. Michael J. Yao M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine A. Tacker M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine A. Tacker M.D. .

Editor information

Editors and Affiliations

  1. Oregon Health and Science University, Department of Psychiatry, Portland, Oregon, USA

    Annette M. Matthews

  2. Maine Medical Center, Department of Psychiatry, Portland, Oregon, USA

    Jonathan C. Fellers

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Yao, M.J., Tacker, K.A. (2016). Managing Chronic Pain in Older Adults. In: Matthews, A., Fellers, J. (eds) Treating Comorbid Opioid Use Disorder in Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-29863-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29863-4_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29861-0

  • Online ISBN: 978-3-319-29863-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation