There are some common pain complaints that you’ll see in the elderly, such as sacroiliitis or chronic low back pain that might be due to facetogenic osteoarthritis. These are conditions that we can see anywhere from 25% to 40% of patients, and even more so in the elderly. Looking at older patients with pain, there are obvious concerns about the interactions of multiple pharmacotherapy agents being used for pain control. There are cognitive deficits that we need to be aware of that can get worse with pain medications. There may be end organ dysfunction, such as kidneys, so that clearance of these medications can be a concern. Patients with heart dysfunction might not be good candidates for even some of the adjuvant medications that we try to encourage. Things like tricyclic antidepressants for pain, which can be helpful, might not be a prudent decision in an elderly patient.
There are other treatment options to consider with older patients, and one of the most promising is radiofrequency ablation which can give long term relief of 6 months to a year. It can be repeated as these nerves grow back, and with very low risk, and can provide a much better way of taking care of pain without having to resort to multipharmacotherapy. With the growth in knee pain in the United States, there are techniques like genicular radiofrequency, with which we can target small nerves in the knee to provide relief for patients who either are too old to have surgery, have too many comorbidities, or for patients who have already had knee replacements.