Intended for healthcare professionals

Clinical Review

Management of chronic pain in older adults

BMJ 2015; 350 doi: (Published 13 February 2015) Cite this as: BMJ 2015;350:h532
  1. M Carrington Reid, associate professor of medicine1,
  2. Christopher Eccleston, director2,
  3. Karl Pillemer, professor of human development and of gerontology in medicine3
  1. 1Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY 10065, USA
  2. 2Centre for Pain Research, University of Bath, Bath, UK
  3. 3Department of Human Development, Cornell University, Ithaca, NY, USA
  1. Correspondence to: M C Reid mcr2004{at}

The bottom line

  • Chronic pain in later life is a worldwide problem

  • All older adults with chronic pain should undergo a comprehensive geriatric pain assessment

  • A comprehensive assessment can guide selection of treatments most likely to benefit the patient and identify targets for intervention besides pain relief

  • A multimodal approach that includes both drug and non-drug modalities for pain is recommended

  • Given the limited reach of cognitive behavioral and exercise approaches to manage pain in later life, patients should be encouraged to engage in and adopt these techniques

  • Involve and engage family members and paid caregivers and seek out other resources that can help to reinforce adherence to treatment and maintain gains from treatment

Chronic pain is one of the most common conditions encountered by healthcare professionals, particularly among older (≥65 years) patients.1 Pain is associated with substantial disability from reduced mobility, avoidance of activity, falls, depression and anxiety, sleep impairment, and isolation.1 2 3 Its negative effects extend beyond the patient, to disrupt both family and social relationships. Chronic pain poses a significant economic burden on society.1 Prevalence rates for pain are expected to increase as populations continue to age—by 2035 an estimated one quarter of the population in the European Union will be 65 or older—thereby increasing the public health impact of pain. Healthcare providers, irrespective of specialty, should develop competencies to assess and manage chronic pain in their older patients. In this review we summarize recent evidence on the assessment and management of pain in older patients. Evidence is taken from systematic reviews, meta-analyses, individual trials, and clinical guidelines.

Sources and selection criteria

We searched Medline, Embase, and the Cochrane Database of Systematic Reviews using the search terms “chronic pain”, “older adults”, “prevalence”, “diagnosis”, and “treatment”. We specifically focused on identifying and reviewing systematic reviews, meta-analyses, high quality randomized controlled trials, …

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