Albrecht M, Hohner E, van Ackern K
Z Gerontol. 1987 Jan-Feb;20(1):23-30.
Today elderly persons represent the largest group of pain patients. Geriatric patients show different pharmacokinetic and pharmacodynamic features of local and systemic analgetic drugs, but there is no evidence that pain threshold changes with the age. The advanced knowledge of the physiological processing of pain (i.e. the role of prostaglandins) influences the treatment and the use of certain drugs. A successful therapy for elderly patients needs a planned action, starting with an exact analysis of the patient's social background, organic functions and pain status. During the course of therapy the patient needs a continuous guidance and his family should have thorough informations to reach an optimal effect. If there is no indication for electrotherapy or regional blocks, we start with a peripherally acting nonnarcotic analgesic. The next step is a combination between this drug and a psychopharmacon. If necessary we add narcotics of the partial agonist type. In case this is not effective we combine a psychopharmacologic agent with a potent agonist narcotic (like morphine). The next step includes the different kinds of spinal opiate application. With these methods we are able to carry out pain therapy (even in difficult cases) providing a high level of well-being, combined with a high grade of physical mobility and mental alertness.
如今，老年人是疼痛患者中最大的群体。老年患者在局部和全身镇痛药方面表现出不同的药代动力学和药效学特征，但没有证据表明疼痛阈值会随年龄变化。对疼痛生理过程的深入了解（即前列腺素的作用）会影响某些药物的治疗和使用。对老年患者的成功治疗需要有计划的行动，首先要对患者的社会背景、器官功能和疼痛状况进行准确分析。在治疗过程中，患者需要持续的指导，其家人也应掌握全面信息以达到最佳效果。如果没有电疗或区域阻滞的指征，我们首先使用外周作用的非麻醉性镇痛药。下一步是将这种药物与一种精神药物联合使用。如有必要，我们会添加部分激动剂类型的麻醉剂。如果这无效，我们会将一种精神药物与强效激动剂麻醉剂（如吗啡）联合使用。下一步包括不同类型的脊髓阿片类药物应用。通过这些方法，我们能够开展疼痛治疗（即使在困难病例中），提供高水平的幸福感，同时具备高度的身体活动能力和精神敏锐度。
