[The rationale of pain therapy in the aged]

Today elderly persons represent the largest group of pain patients. Geriatric patients show different pharmacokinetic and pharmacodynamic features of local and systemic analgetic drugs, but there is no evidence that pain threshold changes with the age. The advanced knowledge of the physiological processing of pain (i.e. the role of prostaglandins) influences the treatment and the use of certain drugs. A successful therapy for elderly patients needs a planned action, starting with an exact analysis of the patient's social background, organic functions and pain status. During the course of therapy the patient needs a continuous guidance and his family should have thorough informations to reach an optimal effect. If there is no indication for electrotherapy or regional blocks, we start with a peripherally acting nonnarcotic analgesic. The next step is a combination between this drug and a psychopharmacon. If necessary we add narcotics of the partial agonist type. In case this is not effective we combine a psychopharmacologic agent with a potent agonist narcotic (like morphine). The next step includes the different kinds of spinal opiate application. With these methods we are able to carry out pain therapy (even in difficult cases) providing a high level of well-being, combined with a high grade of physical mobility and mental alertness.