Reviews Open access

Management of chronic pain in older adults

Authors

Published
4 June 2026
Section
Reviews
DOI
10.4081/gc.2026.14146

Abstract

Chronic pain is highly prevalent among older adults. In this population, comorbidities and polypharmacy often complicate pharmacological management due to an increased risk of adverse effects and drug-drug interactions. At the same time, many patients experience undertreated pain, significantly affecting quality of life. This review highlights current challenges and therapeutic strategies, emphasizing a stepwise, individualized approach that integrates pharmacological and non-pharmacological interventions.

Keywords

References

  1. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020;161:1976-82. DOI: https://doi.org/10.1097/j.pain.0000000000001939
  2. Lin T, Zhao Y, Xia X, et al. Association between frailty and chronic pain among older adults: a systematic review and meta-analysis. Eur Geriatr Med 2002;11:945-59. DOI: https://doi.org/10.1007/s41999-020-00382-3
  3. Abdulla A, Adams N, Bone M, et al. British Geriatric Society. Guidance on the management of pain in older people. Age Ageing 2013;42:i1-57. DOI: https://doi.org/10.1093/ageing/afs200
  4. Culberson JW, Ziska M. Prescription drug misuse/abuse in the elderly. Geriatrics 2008;63:22-31.
  5. Nobili A, Garattini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorb 2011;1:28-44. DOI: https://doi.org/10.15256/joc.2011.1.4
  6. Reid MC, Eccleston C, Pillemer K. Management of chronic pain in older adults. BMJ 2015;350:h532. DOI: https://doi.org/10.1136/bmj.h532
  7. IASP. Terminology. Available from: https://www.iasp-pain.org/ resources/terminology/
  8. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet 2021;397:2082-97. DOI: https://doi.org/10.1016/S0140-6736(21)00393-7
  9. Costantini M, Beccaro M, Di Leo S. Migliorare la qualità delle cure di fine vita. Un cambiamento possibile e necessario. Epidemiol Prev 2011;35:229-33. [Article in Italian].
  10. Corbett A, Achterberg W, Husebo B, et al. An international road map to improve pain assessment in people with impaired cognition: the development of the Pain Assessment in Impaired Cognition (PAIC) meta-tool. BMC Neurol 2014;14:229. DOI: https://doi.org/10.1186/s12883-014-0229-5
  11. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003;4:9-15. DOI: https://doi.org/10.1097/01.JAM.0000043422.31640.F7
  12. Inelmen EM, Mosele M, Sergi G, et al. Chronic pain in the elderly with advanced dementia. Are we doing our best for their suffering? Aging Clin Exp Res 2021;24:207-12. DOI: https://doi.org/10.1007/BF03654801
  13. Bonin-Guillaume S, Jouve E, Lauretta R, et al. Algoplus performance to detect pain in depressed and/or demented old patients. Eur J Pain 2016;20:1185-93. DOI: https://doi.org/10.1002/ejp.844
  14. Horgas AL, Nichols AL, Schapson CA, et al. Assessing pain in persons with dementia: relationships among the non-communicative patient’s pain assessment instrument, self-report, and behavioral observations. Pain Manag Nurs 2007;8:77-85. DOI: https://doi.org/10.1016/j.pmn.2007.03.003
  15. Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs 2000;1:13-21. DOI: https://doi.org/10.1053/jpmn.2000.5831
  16. Abbey J, Piller N, De Bellis AE, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs 2004;10:6-13. DOI: https://doi.org/10.12968/ijpn.2004.10.1.12013
  17. Villanueva MR, Smith TL, Erickson JS, et al. Pain assessment for the dementing elderly (PADE): reliability and validity of a new measure. J Am Med Dir Assoc 2003;4:1-8. DOI: https://doi.org/10.1016/S1525-8610(04)70257-1
  18. HurleyAC, Volicer BJ, Hanrahan P, et al. Assessment of discomfort in advanced Alzheimer patients. Res Nurs Health 1992;15:369-77. DOI: https://doi.org/10.1002/nur.4770150506
  19. McLennan AIG, Winters EM, Gagnon MM, et al. Pain in dementia: a systematic review of the measurement properties of observational assessment tools. Clin Psychol Rev 2026;124:102704. DOI: https://doi.org/10.1016/j.cpr.2026.102704
  20. Ellis-Smith C, Evans CJ, Bone AE, et al. Measures to assess commonly experienced symptoms for people with dementia in long-term care settings: a systematic review. BMC Med 2016;14:38. DOI: https://doi.org/10.1186/s12916-016-0582-x
  21. Lichtner V, Dowding D, Esterhuizen P, et al. Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr 2014;14:138. DOI: https://doi.org/10.1186/1471-2318-14-138
  22. Cherubini A, Laroche ML, Petrovic M. Mastering the complexity: drug therapy optimization in geriatric patients. Eur Geriatr Med 2021;12:431-4. DOI: https://doi.org/10.1007/s41999-021-00493-5
  23. Schofield P, Dunham M, Martin D, et al. Evidence-based clinical practice guidelines on the management of pain in older people – a summary report. Brit J Pain 2020;16:6-13. DOI: https://doi.org/10.1177/2049463720976155
  24. Bonezzi C, Fornasari D, Cricelli C, et al. Pharmacological Management of Adults with Chronic Non-Cancer Pain in General Practice. Pain Ther 2020;9:17-28. DOI: https://doi.org/10.1007/s40122-020-00218-9
  25. Bonezzi C, Fornasari D, Cricelli C, et al. Not all pain is created equal: basic definitions and diagnostic work-up. Pain Ther 2020;9:1-15. DOI: https://doi.org/10.1007/s40122-020-00217-w
  26. Galicia-Castillo MC, Weiner DK. Treatment of chronic non- cancer pain in older adults. In: Schmader KE, Fishman S, Eds. UptoDate; 2021.
  27. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012;64:465-74. DOI: https://doi.org/10.1002/acr.21596
  28. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009;57:1331-46. DOI: https://doi.org/10.1111/j.1532-5415.2009.02376.x
  29. Camilleri M. Opioid-induced constipation: challenges and therapeutic opportunities. Am J Gastroenterol 2011;106:835-42. DOI: https://doi.org/10.1038/ajg.2011.30
  30. Nelson AD, Camilleri M. Opioid-induced constipation: advances and clinical guidance. Ther Adv Chronic Dis 2016;7:121-34. DOI: https://doi.org/10.1177/2040622315627801
  31. Hale M, Wild J, Reddy J, et al. Naldemedine versus placebo for opioid-induced constipation (COMPOSE-1 and COMPOSE-2). Lancet Gastroenterol Hepatol 2017;2:555-64. DOI: https://doi.org/10.1016/S2468-1253(17)30105-X
  32. Häuser W, Morlion B, Vowles KE, et al. European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: role of opioids in the management of chronic noncancer pain. Eur J Pain 2021;25:949-68. DOI: https://doi.org/10.1002/ejp.1736
  33. Colloca G, Lattanzio F, Balducci L, et al. Treating cancer and no-cancer pain in older and oldest old patients. Curr Pharm Des 2015;21:1706-14. DOI: https://doi.org/10.2174/1381612821666150130124926
  34. Carbone M, Magnani L, Guerriero F. Approccio alla strategia terapeutica del dolore nell’anziano. Ital J Med 2015;3: 72-85.
  35. Evans HC, Easthope SE. Transdermal buprenorphine. Drugs 2003;63:1999-2010. DOI: https://doi.org/10.2165/00003495-200363190-00003
  36. Nunziata E, De Siati F, Palleschi L. Efficacy and tolerability of tapentadol in very elderly patients with evaluation of cognitive-behavioral aspects. Geriatric Care 2017;3:6900. DOI: https://doi.org/10.4081/gc.2017.6900
  37. Portenoy RK. A practical approach to using adjuvant analgesics in older adults. J Am Geriatr Soc 2020;68:691-8. DOI: https://doi.org/10.1111/jgs.16340
  38. Vadivelu N, Kai AM, Kodumudi G, et al. Pain and psychology-a reciprocal relationship. Ochsner J 2017;17:173-80.
  39. Couch B, Hayward D, Baum G, et al. A systematic review of steroid use in peripheral nerve pathologies and treatment. Front Neurol 2024;15:1434429. DOI: https://doi.org/10.3389/fneur.2024.1434429
  40. Geneen LJ, Moore RA, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017;4:CD011279. DOI: https://doi.org/10.1002/14651858.CD011279.pub2
  41. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain. Am Psychol 2014;69:153-66. DOI: https://doi.org/10.1037/a0035747
  42. Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003;26:1-7. DOI: https://doi.org/10.1207/S15324796ABM2601_01
  43. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012;172:1444-53. DOI: https://doi.org/10.1001/archinternmed.2012.3654
  44. Johnson MI, Walsh DM. Pain: continued uncertainty of TENS’ effectiveness for pain relief. Nat Rev Rheumatol 2010;6:314-6. DOI: https://doi.org/10.1038/nrrheum.2010.77
  45. Idahor CO, Mokobia S, Ogbonna N, et al. Radiofrequency Ablation for Chronic Pain: Mechanistic Insights and Emerging Innovations. Cureus 2025;17:e99056. DOI: https://doi.org/10.7759/cureus.99056

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2026 the Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.