Pain assessment and management in aging.

Pain in the absence of disease is not a normal part of aging, yet it is experienced daily by a majority of older adults in the United States. Older adults are at high risk for undertreatment of pain due to a variety of barriers. These include lack of adequate education of health care professionals, cost concerns and other obstacles related to the health care system, and patient related barriers, such as reluctance to report pain or take analgesics. Unrelieved pain in the older adult has significant functional, cognitive, emotional, and societal consequences. Pain control begins with a thorough assessment, including an extensive history and physical examination. This information guides the plan of care, including both pharmacologic and nonpharmacologic therapies. Pharmacologic therapies include non-opioids, opioids, and adjuvant analgesics. Nonpharmacologic techniques include cognitive-behavioral strategies, such as distraction, guided imagery, education, and prayer, and physical measures, including heat, massage, bracing, and assistive devices. Health care professionals must be cognizant of the special pain-related needs of this fastest growing segment of the population.