Treatment management must first begin with a proper history and physical to best identify and characterize the type of pain ailing the patient. Lack of knowledge on how to evaluate pain in older adults, especially those who are dependent on staff-provider communications because of assisted living or long-term care facilities, can be a major hindrance in correctly assessing the type of pain.⁴ The likelihood of this pain resulting from current comorbid conditions or previous surgeries is high.¹ Authentic patient history is important when considering pharmacological treatment options, which will be limited by other medical conditions and possible drug interactions. A good quality physical provides background when considering roles of other treatment teams, such as physical therapy, occupational therapy, psychological intervention, or interventional therapies. From there, the physician can identify the patient’s attitude regarding pain and align treatment options with goals of care.

When considering rehabilitation, it is important to understand rehabilitation programs are utilized with the goal to restore function; however, if restoration is unlikely, the treatment can be focused on improving patient disability.¹ For instance, it is well known from studies dating back to the 1990s that strength-training exercises can improve pain and mobility in patients with osteoarthritis.¹ Properly educated and supervised patients are more likely to adhere to recommended training, with encouragement and group exercises increasing positive social interactions and overall hopefulness toward possible pain resolution.¹ Physical therapy has proven to block the transduction of pain signals from the peripheral nervous system to the central nervous system (CNS).¹ Providers must contemplate these nonpharmacological, lower-risk treatment modalities and consider their ability to compliment pain regression through a biopsychosocial approach, perhaps even before considering more risky pharmacological options.

Physiologically, pain begins as a signal at the peripheral nervous system and is eventually transduced to the CNS.¹ This process involves a chain of signals before reaching the CNS. Their individualized activation stimulus highlights the importance of correctly identifying the type of pain. Pharmacological management options discussed will follow the stepwise approach currently advised by WHO.