Balancing Analgesic Efficacy with Safety Concerns in the Older Patient

The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain in older adults create an urgent need to unravel the complexities of chronic pain management in this population. This requires health professionals to understand both normal and pathologic changes that occur within the aging body and mind, as well as how those factors affect responses to pain and pain-relieving treatments. The medical management of pharmacologic treatment for pain in older adults is often suboptimal, ranging from failing to use analgesics for patients with considerable pain to exposing older adults to potentially life-threatening toxicities, overdoses, or drug interactions. Models for safe and effective approaches to treating pain in older adults exist, but treatments must still be tailored for each individual's needs. A growing array of targeted therapies are available for managing pain, yet two or three trials of different agents within the same drug class are often needed to optimize treatment because of the considerable variability in responses to the effects of particular medications. Older adults tend to be more vulnerable to side effects and drug interactions than their younger counterparts, owing to differences in drug distribution, metabolism, and elimination. This review delineates these vulnerabilities and informs clinicians of the strategies needed to promote safe and effective use of medications to treat pain in older adults. The goal of this paper was to review specific considerations for balancing efficacy and safety in the pharmacologic treatment of persistent pain in older adults.