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Pain Management for Older Adults Across the Cognitive Trajectory

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Abstract

Purpose of Review

This review investigated current research on the relationship between chronic pain and cognitive performance, subjective cognitive decline, and dementia. In addition, we reviewed current research on pain management in older adults across the cognitive trajectory.

Recent Findings

Chronic pain remains a common problem in older adults. A new, international classification system highlights the complexity of chronic pain syndromes. Research supports relationships between chronic pain and changes in cognitive performance in generally healthy adults. Evidence also supports associations between pain and subjective cognitive decline, which is considered a possible precursor to dementia. The impact of dementia on pain expression is also reviewed. To manage pain in older adults, we present a multimodal pain management hierarchy that includes pharmacological and non-pharmacological treatments. To avoid the risks and side effects of analgesics, non-pharmacological treatment is recommended as the first line therapy for chronic pain. Medical cannabis and music therapy are two non-pharmacological treatments that have been the focus of substantial recent research; evidence supports their effectiveness in reducing pain and both strategies warrant further investigation.

Summary

Chronic pain is associated with different levels of cognitive decline across the cognitive trajectory. Medical cannabis and music therapy are the two emerging non-pharmacological treatment methods. Clinical studies with rigorous research design are needed to further investigate the effects of these two strategies on pain relief in older adults.

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Fig. 1

Copyright 2020 K. Herr. Modified and used with permission from copyright holder, K. Herr, University of Iowa, College of Nursing on May 2, 2023

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Funding

Dr. Staja Booker is funded through NIH/NIAMS (K23 AR076463). She is a consultant on two NIH-funded research grants. Dr. Booker received Honoria from University of California, Davis, Grambling State University, Nursing Facility Association/Nebraska Assisted Living Association, and the American Nurse journal. Dr. Booker serves on the board of directors of United States Association for the Study of Pain and receives no compensation for this role. 

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  1. University of Florida, College of Nursing, 1225 Center Drive, Gainesville, FL, 32610, USA

    Ann L. Horgas, Jianli Wu & Staja Q. Booker

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  1. Ann L. Horgas
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Correspondence to Ann L. Horgas.

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Conflict of Interest

Dr. Horgas received Honoria from University of California, Davis and has no other financial interests to declare. Dr. Horgas serves on the editorial board for two journals, Research in Gerontological Nursing and Frontiers in Pain, and receives no compensation for these roles. Dr. Ann Horgas had no funding to assist with the preparation to this manuscript. Ms. Jianli Wu had no funding to assist with the preparation to this manuscript and has no financial interests to declare.

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Horgas, A.L., Wu, J. & Booker, S.Q. Pain Management for Older Adults Across the Cognitive Trajectory. Curr Geri Rep 12, 220–227 (2023). https://doi.org/10.1007/s13670-023-00403-6

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