Advanced Reading: Cancer, Elderly & Pain Medications

Older patients are at risk for under-treatment of pain because their sensitivity to pain may be underestimated, they may be expected to tolerate pain well, and misconceptions may exist about their ability to benefit from opioids. Issues in assessing and treating cancer pain in older patients include the following:

• Multiple chronic diseases and sources of pain: Age and complicated medication regimens put older patients at increased risk for interactions between drugs and between drugs and the chronic diseases.
  
  
• Visual, hearing, movement, and thinking impairments may require simpler tests and more frequent monitoring to determine the extent of pain in the older patient.
  
  
• Nonsteroidal anti-inflammatory drug (NSAID) side effects, such as stomach and kidney toxicity, thinking problems, constipation, and headaches, are more likely to occur in older patients.
  
  
• Opioid effectiveness: Older patients may be more sensitive to the pain-relieving and central nervous system effects of opioids resulting in longer periods of pain relief.
  
  
• Patient-controlled analgesia must be used cautiously in older patients, since drugs are slower to leave the body and older patients are more sensitive to the side effects.
  
  
• Other methods of administration, such as rectal administration, may not be useful in older patients since they may be physically unable to insert the medication.
  
  
• Pain control after surgery requires frequent direct contact with health care providers to monitor pain management.
  
  
• Reassessment of pain management and required changes should be made whenever the older patient moves (for example, from hospital to home or nursing home).