Degenerative joint diseases
Cancer-related pain
Osteoporosis-related pain
Herpes zoster
Arterial obliteration
Temporal arteritis
Rheumatic pain
Polyneuropathy
Trigeminal nerve neuralgia
Fracture-related pain
Geriatric nursing home residents have an even higher prevalence of pain, estimated to be between 45 and 80 %. These patients are often untreated or undertreated for pain which has a negative impact on the general health of the elderly and their quality of life. The consequences include depression, anxiety, social isolation, cognitive impairment, immobility and sleep disorders [1–3]. The cause of inadequate pain management may be lack of skills, inappropriate pain assessment and reluctance to prescribe more effective drugs.
Similarly as in other age groups, the elderly patients may have nociceptive, neuropathic or mixed pain (Fig. 28.1) [4, 5]. Nociceptive pain may be visceral or somatic in origin. Nociceptors are stimulated by inflammation or ischemic disorders. Patients with nociceptive pain are treated with both opioid and non-opioid preparations [6, 7], as well as by non-pharmacological interventions. Neuropathic pain is the result of a direct injury of the peripheral or central nervous system; in the elderly this type of pain is associated most frequently with post-herpetic neuralgia and diabetic neuropathy. Neuropathic pain usually does not respond to therapy used in nociceptive pain.
Fig. 28.1
Various pain types and their causes
This type of pain can be controlled by medications from the group of anticonvulsants and antidepressants. The mixed category pain can be treated by medications used in both groups [8–10].
As pain in the elderly has often atypical manifestations, it is believed that its perception differs in older individuals (Tables 28.2 and 28.3). Although pain sensitivity and tolerance vary in individual persons and age groups, it is generally accepted that this variability has no substantial clinical impact. Similarly as other medications used in elderly patients, the administration of analgesics may be associated with a higher incidence of adverse effects. This propensity is due to changes in pharmacokinetics resulting from impaired renal and hepatic function as well as to changes in pharmacodynamics caused by increased sensitivity to analgesics, opiates in particular.
Table 28.2
Categories of chronic non-malignant pain
Neuropathic pain | Inflammatory pain | Generalized pain |
|---|---|---|
Nerve injury Post-herpetic neuralgia Trigeminal nerve neuralgia Amputation Brachial plexus avulsion Peripheral neuropathy Postoperative pain Syringomyelia Spinal cord injury Multiple sclerosis Stroke | Osteoarthritis Rheumatoid arthritis Tendonitis Myositis Colitis Postoperative pain Complex regional pain syndrome Cystitis | Fibromyalgia Musculoskeletal pain Tension headache Irritable bowel syndrome Whiplash injury Lumbago |
Table 28.3
Characteristic features of neuropathic and inflammatory pain
Pain | |||
|---|---|---|---|
Neuropathic | Inflammatory | Generalized | |
Positive signs and symptoms | |||
Spontaneous pain at the lesion site | Yes | Yes | Yes |
Heat hyperalgesia | Rare | Often | Variable |
Cold allodynia | Often | Rare | Rare |
Hyperpathia | Often | No | No |
Subsequent sensations | Often | Rare | Often |
Specific symptoms | Paroxysmal and burning | Throbbing | No |
Pain outside the lesion site | No | No | Yes |
Negative signs and symptoms
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