Treating Older Patients
Older patients are at risk for under-treatment of pain because their
sensitivity to pain may be underestimated, they may be expected to tolerate
pain well, and misconceptions may exist about their ability to benefit from
opioids. Issues in assessing and treating cancer pain in older patients
include the following:
- Multiple chronic diseases and sources of pain: Age and complicated
medication regimens put older patients at increased risk for interactions
between drugs and between drugs and the chronic diseases.
- Visual, hearing, movement, and thinking impairments may require simpler
tests and more frequent monitoring to determine the extent of pain in the
- Nonsteroidal anti-inflammatory drug (NSAID) side effects, such as stomach
and kidney toxicity, thinking problems, constipation, and headaches, are
more likely to occur in older patients.
- Opioid effectiveness: Older patients may be more sensitive to the
pain-relieving and central nervous system effects of opioids resulting in
longer periods of pain relief.
- Patient-controlled analgesia must be used cautiously in older patients,
since drugs are slower to leave the body and older patients are more
sensitive to the side effects.
- Other methods of administration, such as rectal administration, may not be
useful in older patients since they may be physically unable to insert
- Pain control after surgery requires frequent direct contact with health
care providers to monitor pain management.
- Reassessment of pain management and required changes should be made
whenever the older patient moves (for example, from hospital to home or