Journal Mobile

HN Tan, IYO Leong
Journal Issue: 
Volume 38: Issue 2: 2008




Pain  is  a  common  symptom  in  an  older  person  and  is  often  under-managed.  In  this  article,  we  discuss  the  comprehensive  assessment  of  pain  and propose a multidisciplinary approach. The principles of pharmacological treatment are highlighted, while not forgetting the need to consider interventional procedures in appropriate conditions where pain relief can be achieved for a period of time. When prescribing, consideration should be given to the underlying co-morbidities, functional  status  and  psychosocial  situation  of  the  individual,  and  the  patient should be monitored for any improvement of the pain and for the development of any adverse effects. The pharmacological approach follows that of the guidelines of the WHO analgesic ladder. We will also discuss in greater detail the approach to  neuropathic  pain  and  pain  management  in  older  persons  with  cognitive impairment. For neuropathic pain, agents that may be useful include antidepressants, anticonvulsants, opioid analgesics and N-methyl-D-aspartate antagonists. Accurate assessment  of  pain  in  the  older  person  with  cognitive  impairment  poses  a significant barrier to pain management. The principles of management in this group of  individuals  will  be  discussed  and  the  variety  of  pain  behaviours  in  an  older person will be highlighted.