Undertreatment of Pain in Older Adults

The likelihood of experiencing chronic pain increases with age, yet chronic pain is often more challenging to treat in older adults. Untreated or undertreated pain may contribute to a number of physical, mental, and social problems, such as:

  • Reduced mobility1
  • Increased risk of falls1
  • Sleep impairment
  • Anxiety and depression1
  • Social isolation

Understanding the challenges of treating pain in older adults and knowing strategies to deal with them can help decrease people’s pain and increase their enjoyment of life.


Challenges of Treating Pain in Older Adults

There are several challenges that can lead to the undertreatment of pain in older people, such as:

  • The difficulties of assessing pain in older adults.2 These difficulties include:
    • Cognitive impairments, such as stroke or dementia, that may make describing pain or understanding traditional pain assessment tools, such as a numerical scale, difficult.
    • Older adults may not report pain, considering it a normal part of aging or wishing to avoid medication side effects.
  • The presence of multiple chronic conditions or diseases, known as comorbidities, may limit treatment options. For example, a person who is prescribed an anticoagulant (blood thinner) should avoid or limit the use of NSAIDs and acetaminophen for pain relief.

    See Why Taking Pain Medication Can Be Challenging for Older Adults

  • The sedating effects of pain medications may increase risk of falls and fractures.
  • Guidelines from the U.S. Centers for Disease Control and Prevention (CDC) regarding treatment of non-cancer pain have made some doctors apprehensive about prescribing certain medications, including opioids.

See Opioids’ Potential Risks and Side Effects

Understanding these challenges and having honest conversations with a health care provider can help a person achieve adequate and safe pain relief.

Strategies for Addressing Pain in Older Adults

While pain assessment can be challenging at any age, it is particularly complex in older adults. An older adult with chronic pain should have a frank discussion with his or her health care provider.

  • Discuss changes in activities of daily living. People should report if pain prevents them from performing everyday activities, such as getting dressed or cooking a meal.2 Additionally, a caregiver should tell a doctor about any changes in an older adult’s daily routine, as this can be a cue that the person is experiencing pain.
  • Vocalize and report pain. While pain is more common in older adults, it is not considered a normal part of aging and any discomforts should be shared with a health care provider. Descriptions of pain should be as specific as possible. A variety of terms can be used, such as burning, aching, sharp, dull, and throbbing.
  • Provide information about all current medications. A health care provider should be made aware of all medications, including over-the-counter and herbal supplements. Compared to younger people, older adults are more likely to have multiple medical conditions, which means they are more likely to be prescribed multiple medications. Using a limited number of pain medications will decrease risk of adverse drug interactions.

See Managing Pain Medications in Older Adults

This information can help a health care provider make appropriate suggestions for pain control alternatives.

For example, the provider may suggest:

  • Interventional pain management. Consultation with a pain management specialist regarding possible injection therapies for pain may allow to improve functional status and decrease use of oral medications.
  • Assistive devices and physical therapy. To maintain activities of daily living, pain control approaches should be supplemented with appropriate physical therapy rehabilitation, and the use of assistive devices, such as canes, walkers or motorized scooters.
  • Surgery. When coping with progressive and disabling pain conditions, older patients may consider surgeries, such as joint replacement for severe arthritis and spinal laminectomies for advanced spinal stenosis, to permit better quality of life. Recovering from major surgery typically requires short-term use of pain medications and physical therapy.

See Pain Medications: What to Know at Age 65+

A doctor may also check for cognitive impairments, which can inhibit a person from understanding or describing pain. If this is the case, a health care provider may ask to include a trusted family member or a caregiver in these discussions. The health care provider may also provide a referral to a behavioral health professional to address psychological conditions.


CDC guidelines for chronic pain
Stricter CDC guidelines, as well as a changing attitude about opioid use in the United States, have caused doctors to prescribe opioid medications for pain management less often. However, that does not mean that older adults are left without treatment options. Opioid medications still play a role in acute and chronic pain management. Opioid use should occur in conjunction with consultation and monitoring by a clinician trained and experienced in managing pain conditions in older patients. Individual and group wellness programs may also facilitate treatment of chronic pain conditions without use of opioids and should include older adults.

See Managing Chronic Pain Without Opioids


  • 1.Reid MC, Eccleston C, Pillemer K. Management of chronic pain in older adults. BMJ. 2015;350:h532. Published 2015 Feb 13. doi:10.1136/bmj.h532
  • 2.Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179-87.