Assessing and Treating Pain in Older Adults

What is our fundamental responsibility as physicians? Rather than posing a major philosophical question, I am wondering how physicians characterize their daily activities. Obviously, every physician will have a slightly different viewpoint, depending on specialty, type of practice, personality, interests, etc. Some possible responses might be to prevent disease, cure disease, or manage disease and its symptoms. For the average physician, particularly those in primary care and geriatrics, managing disease and its symptoms are what we are commonly doing. And of those symptoms we see, the most important, and the most disabling to our patients, is pain. It is therefore disheartening to see that most publications on the topic continue to document significant undertreatment of pain in older adults.

This issue of Geriatrics & Aging is our attempt to put the issue of pain management in the aging on the front burner where it belongs. Optimal management requires attention to function and symptom control if the quality of life of older patients is to be preserved or even enhanced. Recent research has dispelled the myth of futility of treating neuropathic pain and this is discussed by Drs. Hsiupei Chen and Randall P. Brewer in their article, “A Review of Neuropathic Pain Treatments for the Older Adult.” I am always fascinated that we argue about drugs such as cannabis for pain relief when we underutilize proven remedies such as narcotics. The article “The Use of Narcotics for Pain Management in Older Adults” by Dr. Robert D. Helme provides us with guidance. It is important that we understand all the modalities that our patients use for pain relief and these are discussed in the article “Complementary and Alternative Therapies for Pain in Older Adults” by Drs. Aileen Burford-Mason, Trish Dryden, Merrijoy Kelner, Paul Richard Saunders, and Mark Ware. The important article “Aging and Cultural Disparities in Pain at the End of Life” is provided by Dr. Lucia Gagliese, Rinat Nissim, Melissa Jovellanos, Nataly Weizblit, Wendy Ellis, Dr. Michelle M. Martin, and Dr. Gary Rodin.

We also have our usual collection of interesting articles on a variety of topics. Our cardiovascular column is “Atrial Fibrillation: Etiology, Diagnosis, and Initial Workup” by Drs. Rajneesh Calton, Vijay Chauhan, and Kumaraswamy Nanthakumar. We have an article on musculoskeletal disease, “Polymyalgia Rheumatica,” by Noleen Smith and Dr. Mark Harding. We have part one of an article on “Sudden Deafness” by Drs. Maurice H. Miller and Jerome D. Schein, as well as an article on the oft ignored area of “Asthma in Older Adults” by Dr. Sidney S. Braman. This month’s Drugs and Aging column is entitled “Medication Review for the 10-Minute Consultation: the NO TEARS Tool” by Dr. Tessa Lewis. Finally, Dr. Mark Clarfield invites us to consider who we deem eligible for rehabilitation in his article, “One Step at a Time.”

Enjoy this issue,
Barry Goldlist