[Acute pain management in the elderly - Pharmaceutics and psychosocial approaches]

Post-operative pain management of elderly patients requires special attention. In addition to the organic functional impairments, age-related changes in psychological and social factors play an important role. Also life experiences, painful medical history and a range of different complaints of old age influence the expectations to the treatment of pain. Several factors have to be considered, so 1) age-appropriate preoperative assessment of organic, psychological and social factors, 2) a selection of regularly administered non-opioid, or combination of two different effective non-opioids, notably on the contra-indications and dose limits, 3) if necessary careful titration of the strong opioid with patient adjustment further doses in the recovery room ("start low, go slow"), 4) if necessary, supplement the non-opioid with a strong, not retarded opioid (subcutaneous or oral administration) on the ward, 5) restrictive indication for retarded opioids because of increased risk to fall and constipation, 6) more frequent control of side effects than for younger patients, 7) medical care with increased acceptance of autonomy, to allow trust to improve the often limited compliance and to achieve high patient satisfaction.