Chapter 14: Pain Management in Older Adults

Pain Management in Older Adults addresses the common misconceptions held by both patients and healthcare providers—such as the myth that pain is a normal part of growing old or that older adults have a higher pain threshold—which frequently lead to the under-recognition and undertreatment of symptoms, especially in those with cognitive impairments. The text classifies pain into categories including nociceptive (somatic and visceral), neuropathic, and mixed types, explaining the underlying physiology of afferent and efferent pathways that facilitate the perception of discomfort. A significant portion of the material is dedicated to the clinical challenges of assessment, highlighting that a patient's self-report remains the most reliable indicator of pain. For those unable to communicate, such as individuals with advanced dementia, the chapter introduces specialized assessment frameworks like the Serial Trial Care Protocol (STCP) and functional scales that observe behavioral changes. The management of pain is described through a comprehensive lens, prioritizing the World Health Organization’s three-step analgesic ladder. This includes the cautious use of nonopioids like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and the strategic introduction of opioids and adjuvant medications like anticonvulsants or antidepressants for complex nerve pain. Nurses are encouraged to follow a "start low and go slow" dosing strategy to account for age-related changes in metabolism and organ function while proactively managing side effects like constipation and sedation. Furthermore, the chapter explores a wide range of nonpharmacological interventions, including thermal therapies, transcutaneous electrical nerve stimulation (TENS), music therapy, and relaxation techniques. By utilizing a multidisciplinary team approach, the primary goals are to alleviate suffering, maintain physical mobility, support independent self-care, and ultimately enhance the overall quality of life for the aging population.