Management of chronic pain in old patients: Belgium, Spain and Switzerland

The prevalence of chronic pain increases with age, although solid and comparable epidemiological data addressing the oldest old and specific settings are still sparse. Chronic pain is associated with multimorbidity, disability and reduced quality of life. However, in many cases it goes undetected, it is not adequately screened and assessed, and treatment is suboptimal. Most drugs used for pain treatment carry a higher risk of side effects in older subjects. This paper explores the epidemiology, screening, diagnosis and management of chronic pain in old age in three European countries. Chronic pain may go undiagnosed, as screening programs for identification of this problem are yet uncommon, both in community care and in hospitals and nursing homes. Pain assessment is increasingly (but not universally) a part of comprehensive geriatric assessment, and most geriatricians receive training and seem to be confident in the diagnosis and management of chronic pain in complex or frail patients. Primary care physicians are usually the first providers to manage chronic pain, and only some patients are referred for specialist care. Pain clinics are widely available in the three countries, but older patients do not usually reach them. Acetaminophen is the mainstay of treatment of chronic pain, with reducing – but yet significant – use of NSAIDs and increasing use of weak opioids, mostly tramadol. Strong opioids are not widely used in older subjects, and concerns about side effects and on the choice of drugs in chronic renal disease are still present. Non-pharmacological therapies are not standardised. Attitudes towards chronic pain may hinder identification and management of this highly prevalent geriatric problem.