Pain in Older Adults

Key Points

• Pain in older adults is frequently underreported and undertreated despite major quality-of-life impact.
• Accurate assessment requires combining self-report tools with behavioral and functional observations.
• Pain type, duration, and severity guide individualized treatment choices.
• Best practice is multimodal, integrating pharmacologic and nonpharmacologic interventions.

Pathophysiology

Pain in older adults may originate from visceral, deep somatic, superficial somatic, or neuropathic pathways. Aging, chronic disease, and mental health symptoms can alter pain expression, tolerance, and help-seeking behavior.

Chronic pain can worsen depression, anxiety, sleep disruption, social withdrawal, and functional decline. In psychiatric settings, pain and emotional distress may present together, requiring careful interpretation.

Classification

• By source: Visceral, deep somatic, superficial somatic, neuropathic.
• By duration: Acute pain versus chronic/persistent pain.
• By pattern: Localized, radiating, or referred pain presentations.

Nursing Assessment

NCLEX Focus

If verbal reporting is limited, prioritize behavioral cues, function changes, and validated observational scales.

• Assess pain using PQRSTU format and appropriate numeric/faces/behavioral scales.
• Assess baseline function, gait, posture, sleep, and social participation changes.
• Assess associated mood symptoms, anxiety, and cognitive status that can modify pain expression.
• Assess medication efficacy, side effects, and high-risk combinations.
• Assess family perspectives and care goals to align person-centered management.

Nursing Interventions

• Create individualized multimodal plans combining medication and nonpharmacologic approaches.
• Use repositioning, activity pacing, heat/cold, relaxation, music, and guided breathing as indicated.
• Coordinate physical therapy, mobility support, and safe exercise to preserve function.
• Reassess pain and function after each intervention and adjust plan based on response.
• Educate client and family on realistic goals, safety, and self-management strategies.

Opioid and Fall Risk

Opioids may be necessary for severe pain but require lowest-effective dosing, close monitoring, and fall/delirium precautions.

Pharmacology

Pharmacologic treatment in older adults requires risk-balanced selection due to comorbidities and interaction potential. Nonopioid options are preferred when feasible, but severe pain may require carefully monitored opioid use. Neuropathic pain often responds better to adjuvant agents (for example, selected antidepressants or gabapentinoids) than standard analgesics alone.

Clinical Judgment Application

Clinical Scenario

An older adult with osteoarthritis and depressive symptoms becomes less mobile, socially withdrawn, and reports poor sleep due to persistent pain.

Recognize Cues: Functional decline and mood changes indicate inadequately controlled chronic pain. Analyze Cues: Pain and psychosocial distress are interacting and reinforcing disability. Prioritize Hypotheses: Priorities are function restoration, safety, and sleep improvement. Generate Solutions: Initiate multimodal regimen with scheduled reassessment points. Take Action: Implement medication review, nonpharmacologic supports, and family-aligned goals. Evaluate Outcomes: Improved mobility, sleep, and engagement in daily activities.

Related Concepts

• depressive-disorders - Chronic pain and depression frequently co-occur.
• stress-and-anxiety - Anxiety can increase pain amplification and distress.
• nursing-assessment-and-care-plans - Ongoing reassessment drives effective pain control.
• person-and-family-centered-care - Shared goals improve adherence and outcomes.