Managing Chronic Pain, Psychiatric Comorbidity, and Opioid Dependence in Geriatric Psychiatry: A Case Report

A significant number of elderly patients over the age of 65 presenting to geriatric services are treated with opioids, primarily for pain management. Approximately 25% inpatients are prescribed opioids, this is reflected in geriatric psychiatry too. These patients are often treated over long periods, frequently without adequate opioid stewardship. This often leads to significant adverse effects such as constipation, intoxication, restricted mobility, and other typical side effects of opioid use, including dependence. Across treatment setting, whether inpatient care or community-based care provided by pain specialists, clinics or psychiatrist, alternative treatment options are rarely considered, and adverse effects often receive insufficient attention. In many cases, professionals face pressure from opioid- dependent patients who insist on continuing opioids. The high prevalence of opioid prescriptions and the significant adverse events/side effects make this a structural and systemic challenge, which we aim to highlight through the following case story.