Use of analgesics in the elderly.

Basic and clinical research on the pathophysiology, neurophysiology, biochemistry, and psychology of pain and its management has enhanced our understanding of this complex field. Clinical applications of new knowledge have led to the development of more effective analgesics and better modes of administration in concert with improved technology. However, applications to pain problems unique to the elderly require greater attention. Unfortunately, state-of-the-art analgesic care is not widespread. Barriers exist in knowledge, skills, and attitudes among health care providers. To provide optimal analgesic care, management of each patient should be individualized. The prescribing of standard doses of analgesics should be condemned. An understanding of the various pain problems (acute and chronic) that afflict the elderly, the effects of aging on the pharmacokinetics and pharmacodynamics of analgesics, and the role of specific analgesics for specific pain states is necessary. In addition to analgesics, nonpharmacologic methods of pain control should be utilized. If needed, consultations or referrals to pain clinics or pain centers which provide expert evaluation, recommendations, and/or treatment are available.