Challenges of managing chronic pain in the elderly.

Effective management of chronic pain in the elderly has posed a formidable challenge to the medical community. Practicing physicians are confronted with the complexity of controlling chronic pain in a patient population that often presents with multiple health problems and side effects from long-term use of pain medications. This study presents an overview of commonly encountered barriers to effective management of pain in the elderly and suggests strategies to optimize treatment in this patient population. A high incidence of comorbidities in the elderly frequently necessitates the use of multiple therapies, the combination of which potentially increases the toxicity experienced by this population, which is already particularly susceptible to medication side effects. When determining optimal strategy for managing chronic pain in the elderly, particular attention needs to be paid to past medical history and use of over-the-counter medications. In addition, careful monitoring of age-related changes in physiologic functions is needed, as they may impact drug plasma concentrations and increase susceptibility to adverse events. When traditional pharmacologic agents (such as acetaminophen and nonselective nonsteroidal anti-inflammatory drugs) are deemed inappropriate in high-risk patients because of ineffectiveness or side effects, physicians must consider the use of alternative drugs, such as coxibs, which have comparable efficacy to traditional analgesics, with a superior side effects profile. Copyright 2002, Elsevier Science (USA). All rights reserved.