Management of pain in geriatric patients
© Cambridge University Press 2011.During their third year medicine-surgery clerkships, medical students were observed to become less idealistic about two groups of patients: The elderly and people with chronic pain. Working with elderly patients in pain may thus not only challenge the skills of clinicians, but also frustrate their ideals and expectations about their work. We begin with this observation to suggest that improving pain treatment in older adults is not simply a matter of prescribing the right treatment for the disease and the patient, but also of addressing the psychological barriers that clinicians and patients both face in their attempts to deal with pain. We will argue that the primary difficulty with treating pain in older adults is not the lack of evidence-based treatments, since many exist, but rather the beliefs, expectations, and patterns of behaviors around chronic pain that impair use of potentially effective treatments. In other chronic medical conditions such as hypertension, congestive heart failure, and diabetes, the gap between available treatments and their real-world use is substantial, and adherence to treatment regimens is often low. But the treatment of chronic pain among older adults entails even more complicating issues, such as beliefs about whether pain symptoms are a normal part of aging, whether they should be treated, and whether the treatments are dangerous. Our discussion will focus less on the evidence for specific treatments, and more on how patients use them, what they think of them, and how providers can promote their effective use.
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