“Obese patients can tolerate opioids but require careful monitoring,” Mrs. Snodgrass cautioned. “Those patients with apnea issues can be at particular risk of respiratory sedation.”

The elderly population comprises the fastest growing segment of the world’s population, and pain is a common—although vastly underreported—symptom in this population.  As patients age, the incidence and prevalence of certain pain syndromes increase, Mrs. Snodgrass explained.


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The most common types of pain noted in the elderly include rheumatoid, neuropathic, ischemic, and osteoarthritic pain, Mrs. Snodgrass said.

Assessing these painful conditions can be challenging in this population because often patients are reluctant to report their pain. It is key, she said, to conduct a complete history and physical examination. The most important question to ask older patients who may be in pain is: “Has the pain increased or worsened?”

Discussing the location, intensity, and the effect of the pain on the patient’s mood and sleep is also key, she said.

Mrs. Snodgrass recommended several screenings for older patients in whom pain is suspected, including assessment of cognitive impairment, depression, gait, and sensory depression. 

Clinicians must consider certain health issues that may be more commonly seen in older patients when treating their pain, Mrs. Snodgrass explained, such as aging liver, which may affect hepatic function; aging kidneys, which could lead to a decline in renal function; and central nervous system changes.

All of these conditions influence how older people process medication; therefore, clinicians may want to consider a multidisciplinary approach, which may lessen the need for opioids and the potential for adverse events.