**7. Treatment of pain in older persons**

The management of pain in the elderly can be challenging [14, 15, 35, 42], proper assessment of the pain is very important for its management [44]. Pain management in older persons requires a multidisciplinary approach with the use of non-pharmacological techniques and pharmacological agents that is analgesics and adjuvants [9, 13, 15, 19, 21, 37, 45]. The approach to pain management in older persons differs from that of younger person's [26, 31, 37]. The multidisciplinary approach to pain management in the elderly addresses both the medical and psychosocial requirements of the older person and this involves pharmacotherapy, psychological support and sometimes physical rehabilitation [9, 10, 31] all aimed at the reduction of the pain and improvement of the quality of life [15, 45]. History taking is done; if there is cognitive impairment history may be taken from the caregiver [42]. Older persons cope with pain better than younger people as some people believe that pain is part of the aging process [39].

## **7.1 Non-pharmacological treatment of pain in older persons**

There are many forms of non-pharmacological mode of pain management in older persons, this includes:


#### **7.2 Pharmacological treatment of pain older persons**

The pharmacological management of pain in the elderly involves the use of the three step World Health Organization analgesics ladder, which is an accepted pain plan universally [21, 36, 46]. The pharmacological management of pain in older persons also involves taking into consideration any existent comorbidity and medications taken for other illnesses to avoid drug-drug interactions and side effects [13, 29, 31, 34]. As in the use or administration of any therapeutic agent, older persons are at risk of adverse reactions [13, 15, 31, 38]. Effective pharmacological treatment of pain involves proper assessment of the pain [26]. The physiologic changes associated with aging affect the pharmacokinetics and pharmacodynamics of drugs in the elderly [36]. Multimodality is required which involves the use of different drugs [13, 47]. Traditionally, analgesics are classified into three groups' namely peripheral analgesics such as acetaminophen; nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids.

1.**Acetaminophen:** The pharmacological management of pain in the elderly involves the use of acetaminophen marketed in most countries as paracetamol. Acetaminophen is the commonly used analgesic [10, 36, 44]. It is used in the first step of the pain management ladder of the World Health Organization [10]. The general approach in pain management in the elderly is to start with a non-opioid such as acetaminophen and non-steroidal anti-inflammatory drugs and then use opioids for severe pain [13].

