Perception, Assessment, Treatment, and Management of Pain in the Elderly Robert L. Barkin, PharmD, MBA, DAPM, FCP, NHA a,b, * , Stacy J. Barkin, MA, MED, PsyD Candidate c , Diana S. Barkin, AB d a Department of Anesthesiology, Family Medicine, Pharmacology, and Psychiatry, Rush Medical College, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA b Rush Pain Center, North Shore Pain Center, Rush North Shore Medical Center, 9600 Gross Point Road, Skokie, IL 60076, USA c St. Luke’s Hospital, Scottsdale, AZ, USA d American Journal of Therapeutics, 11-21 North Skokie Valley Highway, Suite 21-G3, Lake Bluff, IL 60044, USA Twenty to 50% of community elderly suffer from pain. Up to 80% of the institutionalized elderly report at least one pain problem (Appendix Box 1). Multiple pain etiologies that occur in elderly patients may be the occurrence of multiple chronic diseases: osteoarthritis, rheumatoid arthritis, cancer, degenera- tive joint disease, bone/joint disorders, osteoporosis, surgical pain, trauma, neuropathic pain, and nociceptive pain (Appendix Box 2). The incidence of unrelieved pain inhibits respiration, decreases mobility, and decreases their functional status, which may lead to iatrogenic events, which include pneumonia, constipation, and deep vein thrombosis. Prolonged inpatient stays and extended care facilities (ECF) or nursing homes may decrease the elderly patient’s quality of life and initiate social isolation. There exists some roadblocks or barriers to the detection of pain in the elderly client. These include social, emotional, cognitive, and subjective issues with the patient. Pain is that which the patient states. Consider the experiential component of pain that includes physiologic and psychosocial issues, the history of the pain complaints and their presentation and past treatments. First consider their ability for coping mechanisms, their 0749-0690/05/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.cger.2005.02.006 geriatric.theclinics.com * Corresponding author. 1211 Blackthorne Lane, Deerfield, IL 60015. E-mail address: rbarkin@rush.edu (R.L. Barkin). Clin Geriatr Med 21 (2005) 465 – 490