Effective chronic pain management can improve quality of life and compliance of elderly patients

Authors: Hana Matějovská Kubešová
Authors‘ workplace: Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno
Published in: Geriatrie a Gerontologie 2021, 10, č. 3: 135-140


The presence of pain causes anxiety, restlessness, impairs the patient‘s ability to cooperate, causes states of confusion and can lead to verbal or physical aggression. Pain has a complex effect on the quality of life not only of the senior himself, but also negatively affects his caregiver. Tenths percent of seniors suffer from chronic pain and its appearance increases further at higher age. About one third sniors living in their owm environment and two thirds of social facility residents are considered to experience long term chronic pain. While the pain threshold increases in elderly patients, the pain tolerance threshold decreases. Despite the obvious consequences of its presence, pain is very often underdiagnosed and insufficiently treated in elderly patients. One of diagnostic difficulties is the cognitive decline, there is necessary to incorporate objective diagnostic tools into pain evaluation on time. An important aspect is the relationship between chronic pain and depression. Chronic pain potentiates the onset or worsening depression, the presence of depression worsens the perception and consequenes of chronic pain. In the treatment of chronic pain in the elderly, it is appropriate to use the positive influence of its psychosocial dimension and to plan the treatment with regard to the patient‘s current compliance.


chronic pain – compliance – depression – cognitive decline – pein treshold – pain tolerance – independence – pain treatment

  1. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol 2015; 29(1): 120–130. 
  2. 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: 1331–1346.
  3. Bielaková K, Matějovská-Kubešová H, Weber P. Léčba bolesti u geriatrických pacientů - známe jejich úskalí? Geri a Gero 2012; 1(2): 91–94.
  4. Coelho T, Paul C, Gobbens RJ, et al. Multidimensional Frailty and Pain in Community Dwelling Elderly. Pain Medicine 2017; 18: 693–701.
  5. Cunningham C. Microglia and neurodegeneration: The role of systemic inflammation. Glia 2013; 61: 71–90.
  6. Deleens R, Pickering G, Hadjiat Y. Pain in the elderly and cognition: state of play. Geriatr Psychol Neuropsychiatr Vieil 2017; 15(4): 345–356.
  7. Dentino A, Medina R, Steinberg E. Pain in the Elderly: Identification, Evaluation, and Management of Older Adults with Pain Complaints and Pain-related Symptoms. Prim Care 2017; 44(3): 519–528.
  8. Fuchs-Lacelle S. Hadjistavropoulos T. Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC) Pain Management Nursing 2004; 5(1): 37–49.
  9. Gross P. Low back pain in elderly. Ther Umsch 2013; 70(9): 523–528.
  10. Gunin AG, Kornilova NK, Vasilieva OV, Petrov VV. Age-related changes in proliferation, the numbers of mast cells, eosinophils, and cd45-positive cells in human dermis. J Gerontol A Biol Sci Med Sci 2011; 66: 385–392.
  11. Hadjistavropoulos K, Herr K, Prkachin KM, et al. Pain assessment in elderly adults with dementia. Lancet Neurol 2014; 13: 1216–1227.
  12. Jones MR, Erhardt KP, Ripoll JG, et al. Pain in the elderly. Curr Pain Headache Rep 2016; 20: 23.
  13. Kaasalainen S, Akhtar-Danesh N, Hadjistavropoulos T, et al. A Comparison Between Behavioral and Verbal Report Pain Assessment Tools for Use with Residents in Long Term Care. Pain Management Nursing 2013; 14(4): e106–e114.
  14. Kalvach Z, Zadák Z, Jirák R, et al. Gerontologie a geriatrie. Grada-Avicenum 2005.
  15. Lloyd DCEF, Harris CM, Roberts D. Specific therapeutic group age-sex related units (STAR-UPs): weighting for analysing general practice’s prescribing in England. BMJ 1995; 311(7011): 991–994.
  16. Kopke K. Non-medication measures for reducing chronic pain in the elderly. A neglected management field for nursing personnel. Pflege Z 2012; 65(11): 656–660.
  17. Mayahara M, Wilbur J, Fogg L. Feasibility of e-Pain Reporter: A Digital Pain Management Tool for Informal Caregivers in Home Hospice. J Hosp Palliat Nurs 2019; 21(3): 193–199.
  18. Merllin I, de Souza B,, Sakaguchi TF, et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics 2019; 74: 789.
  19. Miu DKX, Chan KC. Under-detection of pain in elderly nursing home residents with moderate to severe dementia. J Clin Gerontol Geriatr 2014; 5: 23e27.
  20. Musich S, Wang SS, Slindee L, et al. Association of Resilience and Social Networks with Pain Outcomes Among Older Adults. Popul Health Manag 2019; 22(6): 511–521.
  21. Morrissey MB, Viola D, Shi Q. Relationship between pain and chronic illness among seriously ill older adults: Expanding role for palliative social work. J Soc Work End Life Palliat Care 2014; 10: 8–33.
  22. Paladini A, Fusco M, Coaciolli S, et al. Chronic Pain in the Elderly: The Case for NewTherapeutic Strategies. Pain Physician 2015; 18: E863–E876.
  23. Pickens, Burnett J, Naik AD, et al. Is pain a significant factor in elder self-neglect? J Elder Abuse Negl 2006; 18(4): 51–61.
  24. Rodriguez JC, Dzierzewski JM, Fung CH, et al. Association Between Pain and Functional Independence in Older Adults During and After Admission to Rehabilitation After an Acute Illness or Injury. J Am Geriatr Soc 2015; 63(11): 2275–2281.
  25. Skaper SD, Giusti P, Facci L. Microglia and mast cells: Two tracks on the road to neuroinflammation. FASEB J 2012; 26: 3103–3117.
  26. Souček M, et al. Vnitřní lékařství. Praha: Galén 2015.
  27. Takai Y, Yamamoto-Mitani N, Ko A, et al. Differences in Pain Measures by Mini-Mental State Examination Scores of Residents in Aged Care Facilities: Examining the Usability of the Abbey Pain Scale–Japanese Version. Pain Management Nursing 2014; 15(1): 236–245.
  28. Tarakci E, Zenginler Y, Kaya Mutlu E. Chronic pain, depression symptoms and daily living independency level among geriatrics in nursing home. AGRI 2015; 27(1): 35–41.
  29. Topinková E. Geriatrie pro praxi. Praha: Galén 2005.
  30. Warden V, Hurler AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003; 4(1): 9–15.
  31. Whitlock  EL, Diaz-Ramirez G, Glymour MM, et al. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med 2017; 177(8): 1146–1153.
  32. Wróblewska I, Talarska D, Wróblewska Z. Pain and symptoms of depression: international comparative study on selected factors affecting the quality of life of elderly people residing in institutions in Europe. BMC Geriatrics 2019; 19: 147.
  33. Yücel H, Kayihan H. Pain, physical performance and balance in the elderly at hospital. Arch Gerontol Geriatr 2011; 52(3): 103–105.
  34. Zis P, Daskalaki A, Bountouni I, et al. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging 2017; 12: 709–720.
  35. Zwackhalen SMG, Hamers JPH, Abu-Saad HH, et al. Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools. BMC Geriatrics 2006; 6: 3.
Geriatrics General practitioner for adults Orthopaedic prosthetics

Article was published in

Geriatrics and Gerontology

Issue 3

2021 Issue 3

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account