| Elderly patient is the one of the most difficult patient to | | | | anger, and loss of self-esteem. Social and societal |
| treat because there are too many additional barriers | | | | consequences transform accordingly affecting marital |
| such as impaired cognition, hearing and vision lost that | | | | family reactions; intimacy/sexual activities; increase |
| pain management physician facing during office visit. In | | | | social isolation; health care cost; disability and lost |
| addition, many elderly patients do not want to be seen | | | | workdays. |
| as complainers secondary to their cultural background. | | | | Neuropathic pain treatment in elderly has several goals |
| Typically, elderly patients have multiple comorbidities | | | | such as improving physical functioning; reducing |
| such as hypertension, diabetes, chronic obstructive | | | | psychological distress, and improves overall quality of |
| pulmonary disease, chronic heart failure, and chronic | | | | life. The first-line pharmacological treatment |
| renal failure. There are also many psychological | | | | recommendations for neuropathic pain in elderly would |
| comorbities and social problems such as depression, | | | | be Gabapentin, Lidocaine patch, Tramadol, |
| anxiety, ambulation, socialization and vitality as well. | | | | Antidepressant and Opioid Analgesics. Second line |
| Physician has to remember that in elderly population | | | | treatment of chronic pain in elderly patients would be |
| pain intensity and drugs pharmacokinetics usually | | | | Spinal Cord Stimulator that will allow decreasing all oral |
| diminished as the patient ages. Drug clearance and | | | | medications including opioids. The overall effect would |
| drug half-life is altering with renal excreted medications | | | | be dramatic changes of the quality of life with an |
| and hepatic metabolized medications. Sensitivity of the | | | | improvement of the physical activities and decreasing |
| drugs to central nervous system is also shifting when | | | | all medications' side affect. The third line of treatment |
| the patient aged. | | | | of the chronic pain in elderly population would be an |
| Chronic pain is tremendously affecting elderly people. It | | | | implantation of the intrathecal pump. Intrathecal pump |
| is changing their physical activities; they ability to | | | | will deliver very small dose of medications into spinal |
| perform activities of daily leaving; the work and their | | | | canal and this allows improving the efficacy of these |
| recreation activities. It is also increasing their | | | | medications and eliminating or decreasing general side |
| psychological morbidity such as depression, anxiety, | | | | effects. |