Musculoskeletal pain in the elderly is common and disabling. As the conditions causing rheumatic pain, including osteoarthritis, inflammatory arthritis, and soft-tissue conditions such as tendonitis and bursitis, are, for the most part, not curable, pain control is paramount in order to maintain quality of life. Pain management should be multimodal and tailored to the individual patient, and will likely include a combination of both nonpharmacological and pharmacological interventions. Nonpharmacological treatments begin with the education of the patient, encouragement to practice self-management strategies, and attention to healthy life habits such as weight control and regular physical activity and exercise.
The first step should always be the management of modifiable risk factors, such as weight loss and nutritional counseling
The second step in pain management, involves managing patients' expectations and educating them on what osteoarthritis is and what it is not. To avoid needlessly discouraging patients, clinicians should stress that osteoarthritis is not normal aging, that not all patients will eventually need surgery, and that “wear and tear” are risk factors but not the sole disease mechanisms.
The third step focuses on nonpharmacologic treatments, as outlined by an expert. Specific exercises and physical therapy can help maintain function and range of motion, especially in elderly patients. They can also improve balance in those with significant instability symptoms and can reduce chronic pain, she said. She also noted that many studies have shown benefits from strength training, aerobic and water-based exercise, tai-chi, yoga, and acupuncture.
The fourth and final step in the management of osteoarthritis pain is the use of pharmacologic options, beginning with topical agents, such as capsaicin and diclofenac gel. However, it was noted that although capsaicin has been shown to be effective for knee and hand osteoarthritis pain in clinical trials, it can be problematic in the elderly because it produces a burning sensation and should not be used if skin integrity is compromised.
Successful rheumatic pain management in the elderly should begin with an accurate diagnosis by the physician, and patients must be realistic in their expectations.