Perrot Serge
Service de médecine interne, Hôtel Dieu, Place du Parvis Notre Dame, Paris.
Psychol Neuropsychiatr Vieil. 2006 Sep;4(3):163-70.
Chronic pain has a growing incidence with age. In the elderly, the most frequent etiologies of pain are musculoskeletal diseases, neuropathic pain and cancer. Pain management in older patients requires a comprehensive assessment, adapted to the patient's cognitive functioning, using specific tools, and taking into account the daily life activities and autonomy. Management includes drugs, especially paracetamol and level 2 and 3 opioids. Non steroidal anti-inflammatory drugs (NSAIDs) should be avoided, including COX-2 inhibitors. Drugs are to be prescribed regularly, pre-emptively, and via oral route. Immediate release drugs should be selected, and a slow increase of dosages. Local treatments should be preferred: local injections, topical application and physiotherapy. Rehabilitation, pool-therapy, crenotherapy may be proposed. In conclusion, chronic pain management in elderly patients does not importantly differ from that in younger patients. Specificities are more related to the assessment of pain and to the drugs side effects rather than to the type of drugs.
慢性疼痛的发病率随年龄增长而上升。在老年人中，最常见的疼痛病因是肌肉骨骼疾病、神经性疼痛和癌症。老年患者的疼痛管理需要进行全面评估，使用特定工具，根据患者的认知功能进行调整，并考虑日常生活活动和自主能力。管理方法包括药物治疗，尤其是对乙酰氨基酚以及2级和3级阿片类药物。应避免使用非甾体抗炎药（NSAIDs），包括COX-2抑制剂。药物应定期、预防性地通过口服途径给药。应选择速释药物，并缓慢增加剂量。应优先采用局部治疗：局部注射、局部应用和物理治疗。可建议进行康复治疗、水疗、气候疗法。总之，老年患者的慢性疼痛管理与年轻患者相比并无显著差异。特殊性更多地与疼痛评估和药物副作用有关，而非药物类型。
