Practical Approaches to Pharmacologic Management of Pain in Older Adults With Cancer

Purpose/Objectives: To identify appropriate strategies for pharmacotherapeutic agents in the management of pain in older adults with cancer.

Data Sources: PubMed literature searches, personal reference collection, and clinical experience.

Data Synthesis: To make good decisions about pain management when developing treatment plans for older adults, healthcare providers should focus on the pharmacokinetic and pharmacodynamic properties of drugs in the context of the physiologic changes that occur with aging.

Conclusions: Unrelieved pain can have a detrimental effect on older adults; conversely, overmedicating can lead to an increased risk of adverse events. With advancing age, physiologic changes alter the pharmacokinetic and pharmacodynamic properties of drugs by reducing their absorption, changing their distribution, and modifying their metabolism and elimination. Also, common comorbidities increase the risk of pharmacologic toxicity and narrow the therapeutic window. In addition, polypharmacy—an issue more common in older adults—increases the complexity of prescribing and risk of adverse events. Consequently, older adults require individualization of their pharmacotherapies. Healthcare providers should consider carefully the risks and benefits of nonsteroidal anti-inflammatory drugs, opioids, and adjuvants before initiating an analgesic trial. The 2009 guidelines published by the American Geriatrics Society described several key principles for prescribing analgesics to older adults and offered specific recommendations and caveats for each drug class.

Implications for Nursing: Current guidelines support appropriate management of cancer pain in older adults with specific recommendations for each class of analgesics as well as general prescribing principles.