Pamala D. Larsen, PhD, CRRN
Associate Dean for Academic Affairs,
College of Nursing and Health Professions,
The University of North Carolina at Charlotte, NC, USA.

Although the elderly compose a significant percentage of the surgical patient population, postoperative pain management for this population has received little attention.¹ According to 1990 data, more than 4,000 documents are published annually about pain, but fewer than 1% focus on pain in the older adult.² Lack of published information and research about geriatric pain results in most patients' pain being managed by trial and error.

Considerable evidence suggests that pain is undertreated in older patients. This may be due in part to the misconception that pain sensation diminishes with increasing age or that the elderly patient cannot tolerate narcotic analgesia.³ The perception that older adults have less pain sensitivity than do younger patients is influenced somewhat by the silent myocardial infarctions and emergent 'painless' intra-abdominal surgical events that frequently occur in older adults.⁴ The research involving pain perception in the elderly client provides mixed results. These conflicting results make it difficult to fully establish the relationship or connection between aging and the sensory pain component.

Neil P. Fam, BSc

Arthritis has been called the sleeping giant of Canadian health care. According to Statistics Canada, over 3 million Canadians suffer from osteo-arthritis (OA), with another 300,000 affected by rheumatoid arthritis (RA).¹ Together, these diseases represent one of the leading causes of chronic disability, lost productivity and worker absenteeism in Canada.² As our population ages, more patients are presenting to physicians with musculoskeletal complaints, most of which center around chronic joint pain.

Treatment of the pain of arthritis involves both pharmacologic and non-pharmacologic approaches. Traditionally, treatment of OA and RA has revolved around the use of non-steroidal anti-inflammatory drugs (NSAIDs). Although these medications are often effective in relieving pain, they are associated with significant gastrointestinal and renal complications. Elderly patients are particularly prone to life-threatening complications such as GI bleeding and perforation. For these reasons, other treatment modalities are often utilized. This article presents an overview of pain management strategies, with a focus on OA, the single most common cause of arthritis in seniors.

OA pain

In the management of osteoarthritic pain in the elderly, the best approach is to begin with therapies that are inexpensive and have a low risk of side effects. The following is a stepwise approach, summarized in Table 1.