Older Adults


Pain is not a normal part of aging.  The underlying causes and treatment strategies are similar, though in older adults pain it is often unrecognized and undertreated. Providing adequate pain control can minimize the potentially serious negative physical, psychological, and social consequences associated with pain.


  • The use of pain medication in older adults is associated with a higher risk of complications and adverse events. Common barriers to effective pain management include: clinician inexperience with pain assessment, lack of a clear action plan to treat pain, and overestimation of the risk for opioid tolerance and addiction.   
  • In addition to pharmacologic pain management options, it is essential to maximize nonpharmacological strategies and to avoid undertreatment of acute or persistent pain due to concern for worsening cognitive impairment.  
  • Effective non-pharmacologic approaches include physical therapy, acupuncture and most importantly, patient and caregiver education interventions. Consider placing a referral to a mental health clinician such as a psychiatrist, psychologist, counselor, or integrated primary care specialist who are able to provide cognitive behavioral therapy as a means of treating acute or chronic pain.

Treatment Recommendations

-Treatment of acute pain should start with Tylenol, preferably scheduled, at a maximum daily dose of 3g/day. 

- NSAID therapy should be used with caution and only for short periods of time due to an increased risk for gastrointestinal, renal, and cardiovascular side effects in older adults.  

- Topical NSAIDs such as diclofenac gel has been shown to be efficacious in the treatment of arthritis with minimal risks associated with systemic absorption. 

- Consider other topical agents such as topical lidocaine patches and capsaicin cream for treatment of neuropathic or musculoskeletal pain. 

- Opioid analgesics are the preferred pharmacotherapy for postoperative or severe pain.

Special Considerations

Considerations should be taken to create an optimal pain management plan that balances the risk of:

        Hypo/hyperactive delirium
        Drug interaction
        Altered clearance (dose adjustments, different side-effect profile)



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Perry G. Fine, MD, Treatment Guidelines for the Pharmacological Management of Pain in Older Persons, Pain Medicine, Volume 13, Issue suppl_2, April 2012, Pages S57–S66, https://doi.org/10.1111/j.1526-4637.2011.01307.x

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