
Dr Margaret Dunham
Chair of the Pain in Older People Special Interest Group, British Pain Society
With rising expectancy, older adults encounter more complex pain conditions, often compounded by multimorbidity and cognitive changes, demanding careful consideration of medicines, interventions, side effects and patient experiences.
The UK population aged 65 and over is projected to rise to 27% by 2072 (ONS, 2025), with increasing social and healthcare challenges. Chronic pain rises substantially in this population, often alongside multimorbidity (Bokerman et al, 2024). Many older adults face not only pain but also limitations in mobility, social participation and independence. Age-related changes, including slower information processing and sensory impairments, make pain assessment challenging (Schofield, 2018).
Pharmacological challenges in older adults
Managing pain in older adults is complex. Long-term use of common analgesics, such as paracetamol, are now being questioned (Ahmed, 2023). Pain relief and other medicines used for pain management must be prescribed cautiously; while opioids carry risks (confusion, falls and constipation), though addiction is less of a concern than in younger populations.
The principle ‘start low and go slow’ is key: alongside careful assessment, monitoring and the shortest possible duration for all medicines, especially for those with cognitive impairment. Recent initiatives, such as the NIHR-funded HOPE-AO project, aim to address the risks of analgesic overprescribing in older adults. Given these diverse needs of older adults, alternative interventions are part of a comprehensive pain management strategy.
Non-drug interventions can benefit
older people with chronic pain.
Non-pharmacological approaches
Non-drug interventions can benefit older people with chronic pain, including acupuncture, relaxation, exercise, music therapy, TENS, hydrotherapy and massage (Anderson et al, 2018). Technology-based self-management and peer support have gained traction, particularly since the Covid-19 pandemic (Reid et al, 2018). These approaches may not be suitable for individuals with cognitive impairment or those unable to engage.
Family members often play a key role in supporting engagement and monitoring responses. Patient and professional beliefs also influence outcomes, highlighting the need for continuous education in geriatric pain care.
Lived experience insights
At the heart of holistic pain management are patients’ experiences. Older adults in our current NIHR study share:
- Victoria says: “Long-term pain affects every part of my life, with once-simple tasks now draining more energy.”
- Ann feels dismissed when told, ‘It’s your age,’ believing proper advice could help her live fully.
- Carer Roger highlights the complexity of managing medications.
- Isabella worries about interactions, dizziness, fatigue and constipation from new prescriptions.
This highlights that effective pain management must remain personalised and person-centred, integrating research, clinical expertise and lived experience to meet the complex needs of older adults.