Pain Management in Geriatric Patients

Arzu Gerçek^1*, Yasemin Yazman Arınç²

¹Health Sciences University, Hamidiye International Medical Faculty, Department Of Surgical Medical Sciences

²Department of Anesthesiology and Reanimation, Sultan II. Abdülhamid Han Training and Research Hospital, Istanbul, Türkiye

*Corresponding Author Arzu Gerçek, Dean, Faculty of Health Sciences, University of Health Sciences (SBÜ) Hamidiye, Head of Surgical Departments, International Faculty of Medicine, Email: arzu.gercek@sbu.edu.tr

Abstract

Introduction: Pain has been recognized as the “fifth vital sign” since 1999 due to its significant impact on quality of life [1]. Although the prevalence of pain is high in the geriatric population, it is frequently underrecognized and undertreated [3]. Age-related physiological and pharmacokinetic changes, limited knowledge regarding these alterations, polypharmacy, and communication difficulties significantly complicate pain management in elderly patients [2]. This review evaluates pain management in geriatric patients in terms of pain assessment challenges, pharmacological and non-pharmacological treatment approaches, and interventional pain management techniques in light of current literature [4,7,9].

Methods: In this review, pain management in geriatric patients was evaluated based on current literature with a focus on pain assessment difficulties, pharmacological and non-pharmacological treatment strategies, and Interventional pain management approaches [4,7,9].

Results: Pain assessment in geriatric patients is often inadequate due to sensory deficits, cognitive decline, and the inability to adequately express symptoms [6]. In pharmacological treatment, age-related pharmacokinetic changes necessitate careful dose titration of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) [7,8,10,11]. In chronic pain, adjuvant agents such as antidepressants may provide additional analgesic benefit [12,13].

Non-pharmacological approaches, including physiotherapy, exercise, and psychological interventions, reduce medication requirements while improving quality of life and decreasing drug-related complications [17]. According to the World Health Organization’s analgesic ladder, interventional pain management techniques may be considered in cases where pharmacological and non-pharmacological treatments fail to provide adequate pain control. These include epidural and intra-articular injections, radiofrequency thermocoagulation, neuromodulation, and intradiscal procedures, which have demonstrated efficacy in conditions such as osteoarthritis, spinal stenosis, disc herniation, and neuropathic pain [18-21].

Conclusion: Effective pain management in geriatric patients requires consideration of physiological changes and a multidisciplinary, individualized approach integrating pharmacological, non-pharmacological, and interventional methods [4]. Early application of interventional techniques in appropriately selected patients may significantly improve pain control, functional capacity, and quality of life [18, 21].