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Conservative approach to pain management better for older adults

Conservative approach to pain management better for older adults
Managing pain in older adults should take a balanced approach, a new commentary advises. Photo by Gerd Altmann/Pixabay

March 2 (UPI) -- Pain management in older adults can be accomplished safely with a plan balancing risk and benefit, including drug- and non-drug-based treatment approaches, according to a commentary published Monday in the journal Mayo Clinic Proceedings.

"Chronic pain is very common in older adults, and is often associated with other issues, such as depression, insomnia, social isolation and poor quality of life," co-author Brandon Verdoorn, a geriatrician and internist at Mayo Clinic, said in a press release. "While it's generally not curable, it can be managed with a systematic approach that begins with a thorough, function-based pain assessment followed by recognition and treatment of contributing conditions."

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Chronic pain affects a large proportion of older adults and most long-term care residents, and managing it effectively is essential but challenging. Treating pain has been further complicated by concerns about opioid abuse, given the ongoing opioid epidemic in the United States.

According to Verdoorn, that's why, when managing pain, the emphasis should be on initial low-risk strategies to address it, which typically include non-invasive, non-drug options like exercise, stretching or physical therapy.

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In the study, researchers offers a framework that can help clinicians treating older adult patients with chronic pain, starting with a thorough assessment focusing on function and addressing associated conditions, such as depression and insomnia, simultaneously.

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The researchers recommend treatment begin with low-risk pain management strategies, including non-drug methods that get the patient actively involved in her or his own improvement. And when moving to higher-risk -- often drug-based -- strategies, they say to do so cautiously, while also monitoring patients routinely and discontinuing ineffective options.

"Virtually every patient can benefit from these low-risk options," he said.

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"Some may wonder if pain medications can be safely used in older adults," added co-author Christina Y. Chen, also a Mayo Clinic geriatrician and internist. "This is a timely question, given the opioid crisis. Though many medications used for managing chronic pain can have substantial adverse impacts, it's important to keep in mind that older adults also are affected by a pain epidemic. With judicious use, these medications, including opioids, are important tools for addressing chronic pain, which ultimately affects one's function and independence."

Chen and Verdoorn dispel some commonly held -- and inaccurate or misleading -- beliefs about the effects of pain medications on older adults, noting that opioid medications don't cause delirium and falls as often as many believe.

"Despite conventional wisdom, the idea that opioids cause falls is not supported by current evidence," Verdoorn said, though opioids appear to increase the risk of fracture when a fall occurs. This may affect the pain management strategy for patients who have had falls or are at risk for falling, he added.

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"Though the elements of our framework are not new, they have not previously been conceptualized in this fashion as far as we are aware," Chen noted. "The intent is to provide a useful in-office tool to help guide management of chronic pain. With a careful and systematic approach, pain management can be safely optimized for older adults."

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