Evolving Pharmacological Management of Persistent Pain in Older Persons

Pain medicine is among the youngest subspecialties of medicine and is still in the midst of defining itself. In this process, it is very important to address the needs of the most vulnerable patient populations who have increased burden of illness and pharmacological intake with many potential adverse consequences; one such population is the older patient with persistent pain. The updated guidelines for the pharmacological management of persistent pain in older persons is an important step in keeping the developments in pain management in the older person known to those health care providers who are responsible for their care. Especially useful for the practicing clinicians is the very insightful overview about the general context of pain management, including the crucial role of an adequate pain assessment as the starting point. One of the challenges in publishing guidelines is the goal to be comprehensive and practical while following information from rigorous clinical trials as the gold standard. This guideline, similar to a previous guideline on this topic, is based on clinical standards in the field and on existing data that is often limited in scope and quality. The end product is necessarily a synthesis of the best available evidence [1]. Because the science of pain medicine has evolved slowly, pain guidelines in general and this one in particular are fraught with limitations. In the introductory section, it is stated that the focus is on those age 75 years and older, yet the quality of evidence in this subset of older adults is perhaps more limited than any other. It becomes difficult for the practitioner caring for these individuals who often have multiple and …