Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2016, vol. 22, issue 2
Subject Area: Medicine
Pages: 1149-1153
DOI: 10.5272/jimab.2016222.1149
Published online: 09 June 2016

J of IMAB 2016 Apr-Jun;22(2):1149-1153
Nikolay Yanev1 Corresponding Autor, Mila Vlaskovska2.
1) University Hospital of Maxillo-Facial Surgery, Sofia, Bulgaria
2) Department of Pharmacology and Toxicology, Medical Faculty, Medical University of Sofia, Bulgaria.

The authors surveyed the clinical data and reviewed the literature on the pain management in elderly patients. The conclusion was made that chronic pain in older age is neglected and analgesia is often insufficient. Data for pharmacokinetic and pharmacodynamic characteristics of widely used analgesic drugs are summarized. The authors provide practical guidelines for pain management of elderly people in outpatients departments.

Key words: older age, pain management, analgesic drugs, pharmacokinetics, pharmacodynamics,

- Download FULL TEXT /PDF 493 KB/
Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Yanev N, Vlaskovska M. PAIN IN ELDERLY HAS BEEN OFTEN UNDERESTIMATED. J of IMAB. 2016 Apr-Jun;22(2):1149-1153. DOI:

Correspondence to: Nikolay Yanev, DMD, MD, PhD, University Hospital of Maxillo-Facial Surgery; 1, Georgy Sofiiski blvd., Sofia, Bulgaria; E-mail:

1. Gibson SJ. Older people's pain. Pain: Clinical Updates. 2006; 14:1-4.
2. US Census Bureau International Data Base 2009. Available at: [Internet]
3. US National Center for Health Statistics. National Vital Statistics Reports 2008. Available at: [Internet]
4. Lussier D, Pickering G. Pharmacological considerations in older patients. In: Beaulieu P, Lussier D, Porreca F, Dickenson AH. (Eds.) Pharmacology of pain. Seattle, IASP Press. 2010: 547–565.
5. Brochet B, Michel P, Barberger-Gateau P, Dartigues JF. Population based study of pain in elderly people: a descriptive survey. Age Aging. 1998; 27:279-284.. [CrossRef]
6. Iber FL, Murphy PA, Connor ES. Age-related changes in the gastrointestinal system. Effects on drug therapy. Drugs Aging. 1994 Jul;5(1):34-48. [PubMed]
7. Hämmerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodynamics changes in the elderly. Clinical implications. Clin Pharmacokinet.1998 Jul;35(1):49-64. [PubMed]
8. Grandison MK, Boudinot FD. Age related changes in protein binding of drugs: implications for therapy. Clin. Pharmacokinet. 2000 Mar;38(3):271-290. [PubMed]
9. Butler JM, Begg EJ. Free drug metabolic clearance in elderly people. Clin Pharmacokinet. 2008; 47:297-321. [PubMed]
10. Schmucker DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging. 2001; 18(11):837-51. [PubMed]
11. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16(1):31-41. [PubMed]
12. Kaiko RF. Age and morphine analgesia in cancer patients with postoperative pain. Clin Pharmacol  Ther. 1980 Dec;28(6):823-826. [PubMed]
13. Liukas A, Kuusniemi K, Aantaa R, Virolainen P, Neuvonen M, Neuvonen PJ, et al. Plasma concentrations of oral oxycodone are greatly increased in the elderly. Clin Pharmacol Ther. 2008 Oct;84(4):462-7. [PubMed]
14. Pergolizzi J, Boger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008 Jul-Aug;8(4):287-313. [PubMed]
15. Griessinger N, Sitti R, Likar R. Transdermal buprenorphine in clinical practice: a post-marketing surveillance study in 13179 patients. Current Med Res Opinion. 2005 Aug;21(8):1147-1156. [PubMed]
16. AGS - Ferrell B, Argoff CE, Epplin J, Fine P, Gloth FM, Herr K, et al. Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatric Soc. 2009 Aug;57(8):1331-1345. [PubMed]
17. Abraham NS, EI-Serag HB, Johnson ML, Hartman C, Richardson P, Ray WA, et al. National adherence to evidence-based guidelines for the prescription of non-steroidal anti-inflammatory drugs. J Gastroenterol. 2005 Oct;129(4):1171-1178. [PubMed]
18. Pickering G. Paracetamol use in the elderly. Pain Management. 2008; 1:35-39.
19. Fricke JR Jr, Karim R, Jordan O, Rosenthal N. A double-blind, single-dose comparison of the analgesic efficacy of tramadol/acetaminophen combination tablets, hydrocodone/acetaminophen combination tablets, and placebo after oral surgery. Clin Ther. 2002 Jun;24(6):953-968. [PubMed]
20. Lotrich FE, Pollock BG. Aging and clinical pharmacology: implications for antidepressants. J Clin Pharmacol. 2005 Oct;45(10):1106-1122. [PubMed].

Received: 29 March 2016
Published online: 09 June 2016

back to Online Journal