Principles & Practice of Pain Medicine > Part V. Pain Syndromes > E. Pediatric and Geriatric Pain > Chapter 57. Pain in the Elderly Aida Won

Pain Assessment in the Elderly

"The medical evaluation should begin with a thorough history and physical examination. Because the prevalence of musculoskeletal and neurologic conditions increase with age, special attention should be given to these aspects of the history and physical examination. If the cognitive status of the patient is in question, speak with the primary caregiver to obtain a more reliable history. Always ask about falls and occult trauma in the older population. We should also remember that immobility, contractures, and muscle strain can also be potential sources of musculoskeletal pain. Range-of-motion maneuvers and functional evaluation may reproduce pain and assist in functional assessment. A neurologic examination should also be performed, looking for signs of autonomic, sensory, and motor deficits in order to rule out neuropathic conditions. In addition to establishing a diagnosis, a baseline description of their pain should be made, including intensity, frequency, duration, character of the pain, as well as precipitating and relieving factors. Because many older persons may not refer to their discomfort as pain, but rather use other descriptors such as "ache" and "hurt," we should try to use their language when eliciting a pain history. Documentation of the location of all sites of pain will enable health care professionals target their assessments and determine the functional implications of the pain. It is also helpful to review previous experiences with analgesics, or other therapies. Problems and procedures for the assessment of pain are discussed..."