Submitted by: Alexander Krakovsky
Elderly patient is the one of the most difficult patient to treat because there are too many additional barriers such as impaired cognition, hearing and vision lost that pain management physician facing during office visit. In addition, many elderly patients do not want to be seen as complainers secondary to their cultural background. Typically, elderly patients have multiple comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, chronic heart failure, and chronic renal failure. There are also many psychological comorbities and social problems such as depression, anxiety, ambulation, socialization and vitality as well.
Physician has to remember that in elderly population pain intensity and drugs pharmacokinetics usually diminished as the patient ages. Drug clearance and drug half-life is altering with renal excreted medications and hepatic metabolized medications. Sensitivity of the drugs to central nervous system is also shifting when the patient aged.
Chronic pain is tremendously affecting elderly people. It is changing their physical activities; they ability to perform activities of daily leaving; the work and their recreation activities. It is also increasing their psychological morbidity such as depression, anxiety, anger, and loss of self-esteem. Social and societal consequences transform accordingly affecting marital/family reactions; intimacy/sexual activities; increase social isolation; health care cost; disability and lost workdays.
Neuropathic pain treatment in elderly has several goals such as improving physical functioning; reducing psychological distress, and improves overall quality of life. The first-line pharmacological treatment recommendations for neuropathic pain in elderly would be Gabapentin, Lidocaine patch, Tramadol, Antidepressant and Opioid Analgesics. Second line treatment of chronic pain in elderly patients would be Spinal Cord Stimulator that will allow decreasing all oral medications including opioids. The overall effect would be dramatic changes of the quality of life with an improvement of the physical activities and decreasing all medications side affect. The third line of treatment of the chronic pain in elderly population would be an implantation of the intrathecal pump. Intrathecal pump will deliver very small dose of medications into spinal canal and this allows improving the efficacy of these medications and eliminating or decreasing general side effects.
About the Author: Dr. A. Krakovsky, M.D., PhD., Dr., Sc. is an interventional pain management physician, a professor of medicine and surgery. Dr. Krakovsky leads International Pain Institute in La Jolla, CA providing procedures to elevate pain. Call 858-5519500 or visit