Skip to main content
SpringerLink
Log in
Book cover

Handbook of Pain and Palliative Care pp 175–198Cite as

Persistent Pain in the Older Adult: Practical Considerations for Evaluation and Management

  • Chapter
  • First Online:

  • 1280 Accesses

Abstract

The world’s population age 65 and over exceeds 600 million, and many of these suffer from persistent pain with its multidimensional impact. The clinical manifestations of persistent pain are often complex and multifaceted, so that total pain elimination generally represents an unrealistic goal. That being said, informed clinicians that incorporate evidence-based approaches can help patients manage their discomfort and its associated impacts. Obtainment of improved pain-related outcomes for older adults integrates sound assessment principles, appreciation of age-associated physiologic changes to pain pathways, and realistic goal setting as part of the treatment plan. Component of a comprehensive pain assessment identifies the underlying pain etiology and pain syndrome (e.g., nociceptive, neuropathic, widespread, etc.), informs pharmacological and non-pharmacological treatments of the underlying etiology along with the discomfort itself, and helps clinicians identify facilitators and barriers to successful pain management. As clinicians assess pain and consider treatment approaches, age-associated physiologic changes in pain transduction, conduction, and transmission along with pain perception and modulation should also be considered. The formulation of personalized treatment plans serves to foster a sense of hope with the ultimate goal of successful adaptation to living with persistent pain. Care plans benefit from stepped-care and multimodal approaches, with both non-pharmacological and pharmacological treatments. Treatments vary by pain syndrome with nociceptive, neuropathic, and widespread pain being the focus of the chapter along with considerations for persons with dementia and the opioid epidemic. Taken together, the incorporation of basic skills in pain assessment and management can substantially reduce the burden of persistent pain in older adults with optimization of function and quality of life.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Ablin, J., Fitzcharles, M. A., Buskila, D., Shir, Y., Sommer, C., & Hauser, W. (2013). Treatment of fibromyalgia syndrome: Recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evidence-based Complementary and Alternative Medicine, 2013, 485272.

    PubMed  PubMed Central  Google Scholar 

  • Achterberg, W. P., Pieper, M., van Dalen-Kok, A. H., et al. (2013). Pain management in patient with dementia. Clinical Interventions in Aging, 8, 1471–1482.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alford, D. P. (2016). Opioid prescribing for chronic pain – Achieving the right balance through education. NEJM, 374, 301–303.

    Article  PubMed  Google Scholar 

  • Al-Quliti, K. W. (2015). Update on neuropathic pain treatment for trigeminal neuralgia: The pharmacological and surgical options. Neurosciences, 20, 107–114.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alsaadi, S. M., McAuley, J. H., Hush, J. M., & Maher, C. G. (2011). Prevalence of sleep disturbance in patient with low back pain. European Spine Journal, 20, 737–743.

    Article  PubMed  Google Scholar 

  • Amenta, F., Zaccheo, D., & Collier, W. L. (1991). Neurotransmitters, neuroreceptors and aging. Mechanisms of Ageing and Development, 61, 249–273.

    Article  PubMed  Google Scholar 

  • American Geriatrics Society 2015 Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63, 2227–2246.

    Article  Google Scholar 

  • American Geriatrics Society Panel on Persistent Pain in Older Adults. (2002). The management of persistent pain in older persons. Journal of the American Geriatrics Society, 50, S205–S224.

    Article  Google Scholar 

  • American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. (2009). Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57, 1331–1346.

    Article  Google Scholar 

  • Becker, P. M., & Cohen, H. J. (1984). The functional approach to the care of the elderly: A conceptual framework. Journal of the American Geriatrics Society, 32, 923.

    Article  PubMed  Google Scholar 

  • Berman, B. M., Lao, L., Langenberg, P., et al. (2004). Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Annals of Internal Medicine, 141, 901–910.

    Article  PubMed  Google Scholar 

  • Bosley, B. N., Weiner, D. K., Rudy, T. E., & Graneiri, E. (2004). Is chronic non-malignant pain associated with decreased appetite in older adults? Preliminary evidence. Journal of the American Geriatrics Society, 52, 247.

    Article  PubMed  Google Scholar 

  • Brody, E. M., & Kleban, M. H. (1983). Day-to-day mental and physical health symptoms of older people: A report on health logs. Gerontol, 23, 75–85.

    Article  Google Scholar 

  • Casale, R., & Mattia, C. (2014). Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: Focus on 5% lidocaine-medicated plaster. Therapeutics and Clinical Risk Management, 10, 259–268.

    Article  PubMed  PubMed Central  Google Scholar 

  • CDC. (2016). Promoting health and independence for an aging population at a glance. https://www.cdc.gov/chronicdisease/resources/publications/aag/alzheimers.htm

  • Chakour, M. C., Gibson, S. J., Bradbeer, M., & Helme, R. D. (1996). The effect of age on A delta and C-fiber thermal pain perception. Pain, 64(1), 143–152.

    Article  PubMed  Google Scholar 

  • Chau, D. L., Walker, V., Pai, L., & Cho, L. M. (2008). Opiates and elderly: Use and side effects. Clinical Interventions in Aging, 3, 273–278.

    Article  PubMed  PubMed Central  Google Scholar 

  • Choy, E. H. S., Mease, P. J., Kajdasz, D. K., et al. (2009). Safety and tolerability of duloxetine in the treatment of patients with fibromyalgia: Pooled analysis of data from five clinical trials. Clinical Rheumatology, 28, 1035–1044.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cipher, D. J., Clifford, P. A., & Roper, K. D. (2007). The effectiveness of geropsychological treatment in improving pain, depression, behavioral disturbances, functional disability, and health care utilization in long-term care. Clinical Gerontologist, 30, 23–40.

    Article  Google Scholar 

  • Cole, L. J., Farrell, M., Gibson, S. J., & Egan, G. F. (2010). Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiology of Aging, 31, 494–503.

    Article  PubMed  Google Scholar 

  • Derry, S., Rice, A. S. C., Cole, P., Tan, T., & Moore, R. A. (2013). Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews (2), Art. No.: CD007393. https://doi.org/10.1002/14651858.CD007393.pub3.

  • Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain – United States, 2016. Recommendations and Reports, 65, 1–49.

    Article  PubMed  Google Scholar 

  • Edwards, R. R., Fillingim, R. B., & Ness, T. J. (2003). Age-related differences in endogenous pain modulation: A comparison of diffuse noxious inhibitory controls in healthy older and younger adults. Pain, 101, 155–165.

    Article  PubMed  Google Scholar 

  • Espi-Lopez, G. V., Ingles, M., Reuscas-Nicolau, M. A., & Moreno-Segura, N. (2016). Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia: A pilot study. Complementary Therapies in Medicine, 28, 1–7.

    Article  PubMed  Google Scholar 

  • Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. (2016). Available at: https://addiction.surgoengeneral.gov/surgeon-generals-report.pdf

  • Farrell, M. (2012). Age-related changes in the structure and function of brain regions involved in pain processing. Pain Medicine, 13, S37–S43.

    Article  PubMed  Google Scholar 

  • FDA Introduction to duloxetine. FY 2004 PDUFA performance report. www.fda.gov/AboutFDA/ReportsManualsForms/Reports/UserFeeReports/PerformanceReports/PDUFA/ucm115035.htm#APPENDIXB:ListofApproved Applications. Accessed 30 June 2010.

  • Ferrell, B. A., Ferrell, B. R., & Osterweil, D. (1990). Pain the nursing home. Journal of the American Geriatrics Society, 38, 409–414.

    Article  PubMed  Google Scholar 

  • Fine, P. G., & Herr, K. A. (2009). Pharmacologic management of persistent pain in older adults. Clinical Geriatrics, 17, 25–32.

    Google Scholar 

  • Franceschi, M., Scarcelli, C., Niro, V., et al. (2008). Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: A prospective study of 1,756 patients. Drug Safety, 31, 545–556.

    Article  PubMed  Google Scholar 

  • Galicia-Castillo, M. C., & Weiner, D. K. (2014, September 17). Treatment of persistent pain in older adults. Waltham: UpToDate.

    Google Scholar 

  • Gibson, S. J., & Farrell, M. (2004). A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. The Clinical Journal of Pain, 20, 227–239.

    Article  PubMed  Google Scholar 

  • Gilron, I., Chaparro, L. E., Tu, D., Holden, R. R., Miley, R., et al. (2016). Combination of pregabalin with duloxetine for fibromyalgia: A randomized control trial. Pain, 157, 1532–1540.

    Article  PubMed  Google Scholar 

  • Hadjistavropoulos, T., Herr, K., Turk, D. C., Fine, P. G., Dworkin, R. H., Helme, R., et al. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. The Clinical Journal of Pain, 23(Suppl 1), 1–43.

    Article  Google Scholar 

  • Hanlon, J. T., Guay, D. R. P., & Ives, T. J. (2005). Oral analgesics: efficacy, mechanism of action, pharmacokinetics, adverse effects, drug interactions and practical recommendations for use in older adults. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons, progress in pain research and management. Seattle: IASP Press.

    Google Scholar 

  • He, W., Goodkind, D., & Kowal, P. (2016). An aging world: 2015. International Population Reports [on-line]. Available at https://www.census.gov/content/dam/Census/library/publications/2016/demo/p95-16-1.pdf. Accessed 15 Dec 2016.

  • Herr, K., Coyne, P. J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Management Nursing, 12, 230–250.

    Article  PubMed  Google Scholar 

  • Herr, K., Zwakhalen, S., & Swafford, K. (2016). Observation of pain in dementia. Current Alzheimer Research [published online ahead of print].

    Google Scholar 

  • Hochberg, M. C., Altman, R. D., April, K. T., Benkhalti, M., et al. (2012). American College of Rheumatology 2012 recommendations for the use of non-pharmacological and pharmacological therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 64, 465–474.

    Article  Google Scholar 

  • Hodgson, N. A., & Anderson, S. (2008). The clinical efficacy of reflexology in nursing home residents with dementia. Journal of Alternative and Complementary Medicine, 14, 269–275.

    Article  PubMed  Google Scholar 

  • Hollingshed, J., Duhmke, R. M., & Comblath, D. R. (2006, July 19). Tramadol for neuropathic pain. Cochrane Database of Systematic Reviews, (3), CD006146.

    Google Scholar 

  • Husebo, B. S., Ballard, C., Sandvik, R., Nilsen, O. B., & Aarsland, D. (2011). Efficiency of treating pain to reduce behavioral disturbances in residents of nursing homes with dementia: Cluster randomized clinical trial. BMJ, 343, 1–10.

    Article  Google Scholar 

  • Ifuku, M., Iseki, M., Hidaka, I., Morita, Y., Komatus, S., & Inada, E. (2011). Replacement of gabapentin with pregabalin in postherpetic neuralgia therapy. Pain Medicine, 12, 1112–1116.

    Article  PubMed  Google Scholar 

  • Ing, M. R., Hellreich, P. D., Johnson, D. W., & Chen, J. J. (2015). Transcutaneous electrical nerve stimulation for chronic post-herpetic neuralgia. International Journal of Dermatology, 54, 476–480.

    Article  PubMed  Google Scholar 

  • Institute of Medicine Committee on Advancing Pain Research, Care, and Education. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press (US).

    Google Scholar 

  • Karp, J. F., Reynolds, C. F., 3rd, Butters, M. A., et al. (2006). The relationship between pain and mental flexibility in older adult pain clinic patients. Pain Medicine, 7, 444.

    Article  PubMed  Google Scholar 

  • Karp, J. F., Shega, J. W., Morone, N. E., & Weiner, D. K. (2008). Advances in understanding the mechanisms and management of persistent pain in older adults. British Journal of Anaesthesia, 101(1), 111–120.

    Article  PubMed  Google Scholar 

  • Kuehn, B. M. (2009). FDA focuses on drugs and liver damage: Labeling and other changes for acetaminophen. JAMA, 302, 369–371.

    Article  PubMed  Google Scholar 

  • Larsson, A., Palstam, A., Lofgren, M., Ernerg, M., Bjersing, J., et al. (2015). Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia – Randomized controlled trial. Arthritis Research & Therapy, 17, 161–176.

    Article  Google Scholar 

  • Levy, B., Paulozzi, L., Mack, K. A., & Jones, C. M. (2015). Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. American Journal of Preventive Medicine, 49, 409–413.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lobo, E. D., Quinlin, T., O’Brien, L., Knadler, M. P., & Heathman, M. (2009). Population pharmacokinetics of orally administered duloxetine in patients. Clinical Pharmacokinetics, 48, 189–197.

    Article  PubMed  Google Scholar 

  • Mailis-Gagnon, A., Nicholson, K., Yegneswara, B., et al. (2008). Pain characteristics of adults 65 years of age and older referred to a tertiary care pain clinic. Pain Research & Management, 13, 389–394.

    Article  Google Scholar 

  • Malec, M., & Shega, J. (2015). Pain management in the elderly. Medical Clinics of North America, 99, 337–350.

    Article  Google Scholar 

  • Mason, L., Moore, R. A., Edwards, J. E., et al. (2004). Topical NSAIDs for chronic musculoskeletal pain: Systematic review and meta-analysis. BMC Mulsculoskeletal Disorders, 5, 28.

    Article  Google Scholar 

  • McNicol, E., Midbari, A., & Eisenberg, E. (2013). Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, (8), Art. No.: CD006146. https://doi.org/10.1002/14651858.CD006146.pub.2.

  • Mease, P., Arnold, L. M., Choy, E. H., Clauw, D. J., Crofford, L., et al. (2009). Fibromyalgia syndrome module at OMERACT 9. The Journal of Rheumatology, 36, 2318–2329.

    Article  PubMed  PubMed Central  Google Scholar 

  • Menzies, V. (2016). CE: Fibromyalgia syndrome: Current consideration in symptom management. American Journal of Nursing, 116, 24–32.

    Article  Google Scholar 

  • Morone, N. E., Greco, C. M., Moore, C. G., et al. (2016). A mind-body program for older adults with chronic low back pain: A randomized clinical trial. JAMA Internal Medicine, 176, 329–337.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morrison, R. S., & Siu, A. L. (2000). A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. Journal of Pain and Symptom Management, 19, 240–248.

    Article  PubMed  Google Scholar 

  • Mylius, V., Kunz, M., Henninghausen, E., Lautenbacher, S., & Schepelmann, K. (2008). Effects of ageing on spinal motor and autonomic pain responses. Neuroscience Letters, 446, 129–132.

    Article  PubMed  Google Scholar 

  • Neumann-Podczaska, A., et al. (2016). Analgesic use among nursing home residents, with and without dementia in Poland. Clinical Interventions in Aging, 11, 335–340.

    PubMed  PubMed Central  Google Scholar 

  • Nikolaus, T., & Zeyfang, A. (2004). Pharmacological treatments for persistent non-malignant pain in older persons. Drugs Aging, 21, 19–41.

    Article  PubMed  Google Scholar 

  • Ohayon, M. M., & Schatzberg, A. F. (2003). Using chronic pain to predict depressive morbidity in the general population. Archives of General Psychiatry, 60, 39–47.

    Article  PubMed  Google Scholar 

  • Otis, J. A. D., & McGeeney, B. (2001). Managing pain in the elderly. Clinical Geriatrics, 9, 82–88.

    Google Scholar 

  • Oxman, M. N., Levin, M. J., Johnson, G. R., et al. (2005). A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. The New England Journal of Medicine, 352, 2271–2284.

    Article  PubMed  Google Scholar 

  • Pergolizzi, J. V., Taylor, R., & Rafa, R. B. (2011). Extended-release formulations of tramadol in the treatment of chronic pain. Expert Opinion on Pharmacotherapy, 12, 1757–1768.

    Article  PubMed  Google Scholar 

  • Pergolizzi, J. V., Raffa, R. B., Marcum, Z., Colucci, S., & Ripa, S. R. (2017). Safety of buprenorphine transdermal system in the management of pain in older adults. Postgraduate Medicine, 129, 92–101.

    Article  PubMed  Google Scholar 

  • Pieper, M. J., van Dalen-Kik, A. H., Francke, A. L., et al. (2013). Interventions targeting pain or behavior in dementia: A systematic review. Ageing Research Reviews, 12, 1042–1055.

    Article  PubMed  Google Scholar 

  • Pilgrim, A., & Robinson, S. (2015). An overview of appetite decline in older people. Nursing Older People, 27, 29–35.

    Article  PubMed  PubMed Central  Google Scholar 

  • Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatment for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166, 514–530.

    Article  PubMed  Google Scholar 

  • Reid, M. C., Eccleston, C., & Pillimer, K. (2015). Management of chronic pain in older adults. BMJ, 350, h532.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roy, M. K., Kuriakose, A. S., Varma, S. K., Jacob, L. A., & Beegum, N. J. (2017). A study on comparative efficacy and cost effectiveness of pregabalin and duloxtine used in diabetic neuropahtic pain. Diabetes & Metabolic Syndrome: Clinical research & Reviews, 11, 31–35.

    Article  Google Scholar 

  • Sandvik, R. K., Selbaek, G., Seifert, R., Aarsland, D., Ballard, C., Corbett, A., et al. (2014). Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: A cluster randomized trial. European Journal of Pain, 18, 1490–1500.

    Article  PubMed  Google Scholar 

  • Schwartz, S., Etropolski, M. S., Shapiro, D. Y., Rauschkolb, C., Vinik, A. I., Lange, B., Cooper, K., Van Hove, I., & Haeussler, J. (2015). A pooled analysis evaluating the efficacy and tolerability of tapentadol extended release for chronic, painful diabetic peripheral neuropathy. Clinical Drug Investigation, 35, 95–108.

    Article  PubMed  Google Scholar 

  • Singh, A., & Misra, N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry, 18, 51–55.

    Article  Google Scholar 

  • Spina, E., Santoro, V., & D’Arrigo, C. (2008). Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: An update. Clinical Therapeutics, 30, 1206–1227.

    Article  PubMed  Google Scholar 

  • Steiner, D., Munera, C., Hale, M., et al. (2011a). Efficacy and safety of buprenorphine transdermal system (BTDS) for chronic moderate to severe low back pain: A randomized, double-blind study. The Journal of Pain, 12, 1163–1173.

    Article  PubMed  Google Scholar 

  • Steiner, D. J., Sitar, S., Wen, W., et al. (2011b). Efficacy and safety of the seven day buprenorphine transdermal system in opioid-naive patients with moderate to severe chronic low back pain: An enriched, randomized, double-blind, placebo-controlled study. Journal of Pain and Symptom Management, 42, 903–917.

    Article  PubMed  Google Scholar 

  • Swope, R., & Adams, A. (2012). Prevention and treatment of orthostatic hypotension in the orthopedic patient population. Orthopedics, 35, 600–603.

    Article  PubMed  Google Scholar 

  • Tetreault, P., Mansour, A., Vachon-Presseau, E., et al. (2016). Brain connectivity predicts placebo response across chronic pain clinical trials. PLoS Biology, 14, 1–22.

    Article  Google Scholar 

  • Tsang, A., Von Korff, M., Lee, S., et al. (2008). Common persistent pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. The Journal of Pain, 9, 883–891.

    Article  PubMed  Google Scholar 

  • Vorsanger, G., Xiang, J., Jordan, D., & Farrel, J. (2007). Post hoc analysis of a randomized, double-blind, placebo-controlled efficacy and tolerability study of tramadol extended release for the treatment of osteoarthritis pain in geriatric patients. Clinical Therapeutics, 29, 2520–2535.

    Article  PubMed  Google Scholar 

  • Walhovd, K. B., Westlye, L. T., Amlien, I., et al. (2011). Consistent neuroanatomical age-related volume differences across multiple samples. Neurobiology of Aging, 32(5), 916–932.

    Article  PubMed  Google Scholar 

  • Walitt, B., Urrutia, G., Nishishinya, M. B., Cantrell, S. E., & Hauser, W. (2015). Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database of Systematic Reviews, 6, 1–65.

    Google Scholar 

  • Warden, V., Hurley, A. C., & Volicer, L. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association, 4(1), 9–15.

    Article  PubMed  Google Scholar 

  • Weiner, D. K., Haggerty, C. L., Kritchevsky, S. B., et al. (2003). How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Medicine, 4, 311.

    Article  PubMed  Google Scholar 

  • Weiner, D. K., Rudy, T. E., Morone, N., Glick, R. M., & Kwoh, C. K. (2007). Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: An initial controlled clinical trial. Journal of the American Geriatrics Society, 55, 1541–1547.

    Article  PubMed  Google Scholar 

  • Weiner, D. K., Karp, J. F., Bernsetin, C. D., & Morone, N. E. (2013a). Pain medicine in older adults: How should it differ? In Treatment of chronic pain by integrative approaches (pp. 233–258). New York: Springer.

    Google Scholar 

  • Weiner, D. K., Moore, C. G., Morone, N. E., Lee, E. S., & Kwoh, C. K. (2013b). Efficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: A randomized controlled clinical trial. Clinical Therapeutics, 35, 1703–1720.

    Article  PubMed  Google Scholar 

  • Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., et al. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia-report of the multicenter criteria committee. Arthritis and Rheumatism, 33, 160–172.

    Article  PubMed  Google Scholar 

  • Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., et al. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62, 600–610.

    Article  PubMed  Google Scholar 

  • Wolfe, F., Clauw, D. J., Fitzchlarles, M. A., Goldenberg, D. L., et al. (2016). 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 46, 319–329.

    Article  PubMed  Google Scholar 

  • Yezierski, R. P. (2012). The effects of age on pain sensitivity: Pre-clinical studies. Pain Medicine, 13, S27–S36.

    Article  PubMed  Google Scholar 

  • Zakrzewska, J. M. (2010). Medical management of trigeminal neuropathic pains. Expert Opinion on Pharmacotherapy, 11, 1239–1254.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Alisha Hemraj MD

  2. Section of Geriatrics and Palliative Medicine, University of Chicago Department of Medicine, Chicago, IL, USA

    Monica Malec MD

  3. Vitas Healthcare, Miami, FL, USA

    Joseph W. Shega MD

  4. University of Central Florida, Orlando, FL, USA

    Joseph W. Shega MD

  5. Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Debra K. Weiner MD

  6. Departments of Geriatric Medicine, Psychiatry, Anesthesiology, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

    Debra K. Weiner MD

Authors
  1. Alisha Hemraj MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monica Malec MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph W. Shega MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Debra K. Weiner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Alisha Hemraj MD or Debra K. Weiner MD .

Editor information

Editors and Affiliations

  1. Bethesda, MD, USA

    Rhonda J. Moore

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hemraj, A., Malec, M., Shega, J.W., Weiner, D.K. (2018). Persistent Pain in the Older Adult: Practical Considerations for Evaluation and Management. In: Moore, R. (eds) Handbook of Pain and Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-95369-4_11

Download citation

Publish with us

Policies and ethics

Search

Navigation