Assessment and management of chronic pain in the older adult.

OBJECTIVE To review the assessment and recommended management of mild to moderate chronic pain in the older adult. DATA SOURCES Medline search using the terms pain, older adult, and analgesics, current national guidelines, and authors' case experiences. DATA SYNTHESIS Assessing pain in cognitively intact and impaired older adults is essential to safe use of psychoactive medications. Following the guidelines of the American Geriatrics Society for persistent pain in the older adult provides guidance to the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, in order to avoid gastrointestinal, renal, and cardiovascular complications. Potentially inappropriate opioid analgesics and safer alternatives are encouraged. A description of other psychoactive medications for neuropathic pain and the role of vitamin D and depression in chronic pain is provided. CONCLUSION The assessment of pain and use of analgesics in the older adult should benefit and not increase drug-related morbidity and mortality.