Pain is a common symptom in an older person and is often under-managed. In this article, we discuss the comprehensive assessment of pain and propose a multidisciplinary approach. The principles of pharmacological treatment are highlighted, while not forgetting the need to consider interventional procedures in appropriate conditions where pain relief can be achieved for a period of time. When prescribing, consideration should be given to the underlying co-morbidities, functional status and psychosocial situation of the individual, and the patient should be monitored for any improvement of the pain and for the development of any adverse effects. The pharmacological approach follows that of the guidelines of the WHO analgesic ladder. We will also discuss in greater detail the approach to neuropathic pain and pain management in older persons with cognitive impairment. For neuropathic pain, agents that may be useful include antidepressants, anticonvulsants, opioid analgesics and N-methyl-D-aspartate antagonists. Accurate assessment of pain in the older person with cognitive impairment poses a significant barrier to pain management. The principles of management in this group of individuals will be discussed and the variety of pain behaviours in an older person will be highlighted.
