Pain Management Strategies for Older Adults in Palliative Care: A Scoping Review

With the aging population, the demand for palliative care is expected to increase. Pain management is a critical component of palliative care with unique considerations for older patients. The aim of this scoping review was to map the nature and extent of the evidence on pain management strategies in this population.

We searched databases for peer-reviewed studies and grey literature on pain management in older adults receiving palliative care. Strategies were classified as opioid analgesics, non-opioid medications, procedural, non-pharmacological, educational, and multifaceted interventions. Frequencies and proportions were used to describe the strategies, reported improvements, and levels of evidence.

We included 117 studies. Most focused on cancer populations (82/117, 71%), and the majority of participants (98/114, 86%) were aged 65-74 years on average. Overall, 68% of the studies yielded moderate to low level of evidence. Opioids and multifaceted interventions were the most frequently evaluated strategies, each examined in 32% (37/117) of studies. Across both high- and moderate/low-evidence studies, pain reduction was most consistently reported for procedural interventions (3/3, 100%; 3/3, 100%), opioids (3/5, 60%; 25/32, 78%), and multifaceted interventions (4/9, 44%; 20/23, 87%). Favourable findings were most often reported for combinations of opioids, opioids for breakthrough pain, nerve blocks or local anesthesia, cannabis, music or massage therapy, exercise, and biopsychosocial or care organization interventions.

This review mapped pain management strategies for older adults in palliative care, identified key evidence gaps, particularly among oldest-old individuals and those with non-cancer conditions, and highlighted the need for stronger research.