Skip to main content
SpringerLink
Log in

Treatment of Chronic Non-Malignant Pain in the Elderly

Safety Considerations

  • Review Article
  • Published:
Drug Safety Aims and scope Submit manuscript

Abstract

Non-malignant pain in the elderly is frequently under-treated, with physicians appearing to be uncertain concerning how best to achieve optimum management of this common problem in individual cases. The aim of this review is to provide a brief overview and discuss the variety of interacting factors that contribute to the continuing under-treatment of chronic non-malignant pain in the older population. The central objective is to encourage safer and more effective pain management in a population that is highly vulnerable to painful conditions and to the consequences of poorly treated pain.

Under-treatment of pain as experienced by the elderly is largely a consequence of uncertainties that arise within a complex environment that is underscored and exacerbated by the progressive and rapid aging of the global population. Uncertainties include the optimum management of pain in geriatric syndromes, frailty and dementia, and their impact on diagnosis, pain assessment and choices of treatment modalities. There is an inadequate evidence base for pharmacological interventions in older persons with respect to pharmacokinetic and pharmacodynamic changes that occur with aging. In this review, the prevalence of chronic pain and the incidence of adverse drug reactions are identified as factors that encourage conservatism in prescribing, as are major predictors of adverse drug reactions, i.e. aging, inappropriate combinations of medications and polypharmacy.

The major classes of analgesic drugs are summarized with reference to their mechanisms of action, analgesic properties and known adverse effects. Although all medications have associated risks, the use of analgesics in managing persistent pain in elderly people is widely supported and guided on the basis of clinical experience and consensus among specialists in geriatrics and pain management.

It is concluded that the absence of trial data, specific to the elderly, is substantially offset by information based on clinical experience and expert consensus statements. Used appropriately, analgesic and adjuvant treatments can and should be employed to relieve persistent pain in the expanding elderly population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

References

  1. Hadjistavropoulos T, Herr K, Turk DC, et al. An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007; 23 Suppl.: S1–43

    Article  PubMed  Google Scholar 

  2. American Geriatrics Society Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002; 50: S205–24

    Article  Google Scholar 

  3. Kung F, Gibson SJ, Helme RD. Development of a pain management strategies survey questionnaire: preliminary findings. Pain Clinic 2000; 12: 299–315

    Article  Google Scholar 

  4. Feinberg SD. Prescribing analgesics: how to improve function and avoid toxicity when treating chronic pain. Geriatrics 2000; 55: 44, 49–50, 53 passim

    PubMed  CAS  Google Scholar 

  5. Helme RD. Chronic pain management in older people. Eur J Pain 2001; 5 Suppl. A: 31–6

    Article  PubMed  Google Scholar 

  6. Hanlon JT, Guay DRP, Ives TJ. Oral analgesic: efficacy, mechanism of action, pharmacokinetics, adverse effects, drug interactions, and practical recommendations for use in older adults. In: Gibson SJ, Weiner DK, editors. Pain in older persons. Seattle (WA): IASP Press, 2005: 3–22

    Google Scholar 

  7. United Nations, Department of Economic and Social Affairs. World economic and social survey 2007: development in an ageing world [online]. Available from URL: http://www.un.org/esa/policy/wess/wess2007files/wess2007.pdf [Accessed 2009 Mar 26]

  8. United Nations, Department of Economic and Social Affairs, Population Division. Population ageing 2006 [online]. Available from URL: http://www.un.org/esa/socdev/ageing/documents/ageing2006chart.pdf [Accessed 2009 March 26]

  9. Kirkwood TB, Austad SN. Why do we age? Nature 2000; 408: 233–8

    Article  PubMed  CAS  Google Scholar 

  10. McLean AJ, Le Couter DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004; 56: 163–84

    Article  PubMed  CAS  Google Scholar 

  11. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: key indicators of well-being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: US Government Printing Office, Mar 2008

    Google Scholar 

  12. Nair BR. Evidence based medicine for older people: available, accessible, acceptable, adaptable? Aust J Ageing 2002; 21(2) 58–60

    Article  Google Scholar 

  13. National health survey: summary of results, Australia 2004–05. Canberra (ACT): Australian Bureau of Statistics, 2006

  14. Inouye SK, Studenski S, Tinetti MD, et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780–91

    Article  PubMed  Google Scholar 

  15. Flacker JM. What is a geriatric syndrome anyway? J Am Geriatr Soc 2003; 51: 574–6

    Article  PubMed  Google Scholar 

  16. Olde Rikkert MGM, Rigaud A-S, van Hoeyweghen RJ, et al. Geriatric syndromes: medical misnomer or progress in geriatrics. J Med 2003; 61(3): 83–7

    CAS  Google Scholar 

  17. Flood KL, Rohlfing A, Le CV, et al. Geriatric syndromes in elderly patients admitted to an inpatient cardiology ward. J Hosp Med 2007; 2: 394–400

    Article  PubMed  Google Scholar 

  18. Anpalahan M, Gibson SJ. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J 2008; 38: 16–23

    PubMed  CAS  Google Scholar 

  19. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. Cardiovascular Health Study Collaborative Research Group. J Gerontol Series A Biol Sci Med Sci 2001; 56(3): M146–56

    Article  CAS  Google Scholar 

  20. Parmalee PA, Smith B, Katz IR. Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc 1993; 41: 517–22

    Google Scholar 

  21. Hadjistavropoulos T, Craig T, Martin N, et al. Toward a research outcome measure of pain in frail elderly in chronic care. Pain Clin 1997; 10: 71–9

    Google Scholar 

  22. Cole LJ, Farrell MJ, Duff EP, et al. Pain sensitivity and fMRI pain-related brain activity. Brain 2006; 129: 2957–65

    Article  PubMed  Google Scholar 

  23. Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: a one minute numerical indicator for people with end stage dementia. Int J Palliat Nurs 2004; 10: 6–13

    PubMed  Google Scholar 

  24. Feldt KS. The checklist of non-verbal pain indicators (CNPI). Pain Manag Nurs 2000; 1: 13–21

    Article  PubMed  CAS  Google Scholar 

  25. Snow AL, Weber JB, O’Malley KJ, et al. NOPPAIN: a nursing assistant-administered pain assessment instrument for use in dementia. Dement Geriatr Cogn Disord 2004; 17: 240–6

    Article  PubMed  Google Scholar 

  26. McMurdo ME. Including older people in clinical research: benefits shown in trials in younger people may not apply to older people. BMJ 2005; 331: 1036–7

    Article  PubMed  Google Scholar 

  27. Bugeja G, Kumar A, Banerjee AK. Exclusion of elderly people from clinical research: a descriptive study of published reports. BMJ 1997; 315: 1059–60

    Article  PubMed  CAS  Google Scholar 

  28. Vogt TM, Ireland CC, Black D, et al. Recruitment of elderly volunteers for a multicenter clinical trial: the SHEP pilot study. Control Clin Trials 1986; 2: 118–33

    Article  Google Scholar 

  29. Bowes SG, Dobbs SM, Dobbs RJ, et al. Outcome criteria in clinical trials with elderly subjects. Age Ageing 1990; 19: 353–5

    Article  PubMed  CAS  Google Scholar 

  30. Pahor M, Guralnik JM, Wan JY, et al. Lower body osteoarticular pain and dose of analgesic medications in older disabled women: the women’s health and aging study. Am J Public Health 1999; 89: 930–4

    Article  PubMed  CAS  Google Scholar 

  31. Chodosh J, Solomon DH, Roth CP, et al. The quality of medical care provided to vulnerable older patients with chronic pain. J Am Geriatr Soc 2004; 52: 756–61

    Article  PubMed  Google Scholar 

  32. Gibson SJ. IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother 2007; 7: 627–35

    Article  PubMed  Google Scholar 

  33. Scherder EJ, Bouma A. Is decreased use of analgesics in Alzheimer disease due to change in the affective component of pain? Alzheimer Dis Assoc Disord 1997; 11: 171–4

    Article  PubMed  CAS  Google Scholar 

  34. Horgas AL, Tsai PF. Analgesic drug prescription and use in cognitively impaired nursing home residents. Nurs Res 1998; 47: 235–42

    Article  PubMed  CAS  Google Scholar 

  35. Won AB, Lapane KL, Vallow S, et al. Persistent non-malignant pain and analgesic prescribing patterns in elderly nursing home residents. J Am Geriatr Soc 2004; 52: 867–74

    Article  PubMed  Google Scholar 

  36. Lamberg L. Chronic pain linked with poor sleep: exploration of causes of treatment. JAMA 1999; 281: 691–2

    Article  PubMed  CAS  Google Scholar 

  37. Duggleby W, Lander J. Cognitive status and postoperative pain: older adults. J Pain Symptom Manage 1994; 9: 19–27

    Article  PubMed  CAS  Google Scholar 

  38. Scudds RJ, Robertson JM. Empirical evidence of the association between the presence of musculoskeletal pain and physical disability in community-dwelling senior citizens. Pain 1998; 75: 229–35

    Article  PubMed  CAS  Google Scholar 

  39. Kroenke K, Shen J, Oxman TE, et al. Impact of pain on outcomes of depression treatment: results from the RESPECT trial. Pain 2008; 134: 209–15

    Article  PubMed  Google Scholar 

  40. Rabenda V, Burlet N, Ethgen O, et al. A naturalistic study of the determinants of health related quality of life improvement in osteoarthritic patients treated with nonspecific non-steroidal anti-inflammatory drugs. Ann Rheum Dis 2005; 64: 688–93

    Article  PubMed  CAS  Google Scholar 

  41. Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthrit Res Ther 2005; 7(5): R1046–51

    Article  CAS  Google Scholar 

  42. Gagliese L, Farrell MJ. The neurobiology of aging, nociception and pain: an integration of animal and human experimental evidence. In: Gibson SJ, Weiner DK, editors. Pain in older persons. Seattle (WA): IASP Press, 2005: 25–44

    Google Scholar 

  43. Gibson SJ, Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain 2004; 20: 227–39

    Article  PubMed  Google Scholar 

  44. Gibson SJ, Helme RD. Age differences in pain perception and report: a review of physiological, psychological, laboratory and clinical studies. Pain Rev 1995; 2: 111–37

    Google Scholar 

  45. Jones GT, Macfarlane GA. Epidemiology of pain in older persons. In: Gibson SJ, Weiner DK, editors. Pain in older persons. Seattle (WA): IASP Press, 2005: 3–22

    Google Scholar 

  46. Gibson SJ, Helme RD. The epidemiology of pain in elderly people. Clin Geriatr Med 2001; 3: 417–31

    Google Scholar 

  47. Unwin M, Symmons D, Allison T, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998; 57: 649–55

    Article  Google Scholar 

  48. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients. JAMA 1998; 279: 1200–5

    Article  PubMed  CAS  Google Scholar 

  49. Kvasz M, Allen IE, Gordon MJ, et al. Adverse drug reactions in hospitalized patients: a critique of a meta-analysis [abstract]. Med Gen Med 2000 Apr 27; 2(2): E3

    CAS  Google Scholar 

  50. Wiffen P, Gill M, Edwards J, et al. Adverse drug reactions in hospital patients: a systematic review of the prospective and retrospective studies, June 2002 [online]. Available from URL: http://www.ebandolier.com [Accessed 2008 Feb 12]

  51. Patel H, Bell D, Molokhia M, et al. Trends in hospital admissions for adverse drug reactions in England: analysis of national hospital episode statistics 1998–2005 [abstract]. BMC Clin Pharmacol 2007 Sep 25; 7: 9

    Article  PubMed  Google Scholar 

  52. Burgess CL, D’Arcy C, Holman J, et al. Adverse drug reactions in older Australians: 1981–2002. Med J Aust 2005; 182: 267–70

    PubMed  Google Scholar 

  53. Ogilvie RI, Ruedy J. Adverse drug reactions during hospitalization. Can Med Assoc J 1967; 97: 1450–7

    PubMed  CAS  Google Scholar 

  54. Carbonin P, Pahor M, Bernabei R, et al. Is age an independent risk factor of adverse drug reactions in hospitalised medical patients? J Am Geriatr Soc 1991; 39: 1093–9

    PubMed  CAS  Google Scholar 

  55. Zhang M, Holman CDJ, Preen DB, et al. Repeat adverse drug reactions causing hospitalisation in older Australians: a population-based longitudinal study 1980–2003. Brit J Clin Pharm 2007; 63: 163–70

    Article  PubMed  Google Scholar 

  56. Steinman MA. Polypharmacy and the balance of medication benefits and risks. Am J Geriatr Pharmacother 2007; 5: 314–5

    Article  PubMed  Google Scholar 

  57. Barry PJ, Gallagher P, Ryan C. Inappropriate prescribing in geriatric patients. Cur Psychiatr Rep 2008; 10: 37–43

    Article  Google Scholar 

  58. Solomon DH. NSAIDs: cardiovascular effects. UpToDate®, the clinical information service on the web, desktop, and PDA devices [online]. Available from URL: http://www.uptodate.com/home/store/index.do [Accessed 2008 Nov 11]

  59. Analgesic Expert Group. Therapeutic guidelines: analgesia. Version 5. Melbourne: Therapeutic Guidelines Ltd, 2007

    Google Scholar 

  60. McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997; 156: 385–91

    PubMed  CAS  Google Scholar 

  61. Naugler CT, Brymer C, Stolee P, et al. Development and validation of an improved prescribing for the elderly tool. Can J Clin Pharmacol 2000; 7: 103–17

    PubMed  CAS  Google Scholar 

  62. Hanlon JT, Schmader KE, Samsa GP. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992; 45: 1045–51

    Article  PubMed  CAS  Google Scholar 

  63. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003; 163: 2716–24

    Article  PubMed  Google Scholar 

  64. Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 2007; 63: 725–31

    Article  PubMed  Google Scholar 

  65. Johnell K, Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: 473 a study of over 600 000 elderly patients from the Swedish Prescribed Drug Register. Drug Safety 2007; 30: 911–8

    Article  PubMed  Google Scholar 

  66. Beyth RJ, Shorr RI. Epidemiology of adverse drug reactions in the elderly by drug class. Drugs Aging 1999; 14: 231–9

    Article  PubMed  CAS  Google Scholar 

  67. Hajjir ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007; 5: 345–51

    Article  Google Scholar 

  68. Ballantyne JC, Mao J. Medical progress: opioid therapy for chronic pain. N Engl J Med 2003; 349: 1943–53

    Article  PubMed  CAS  Google Scholar 

  69. Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Clinical trials (ESCISIT). Ann Rheum Dis 2003; 62: 1145–55

    Article  PubMed  CAS  Google Scholar 

  70. Gloth FM. Pain management in older adults: prevention and treatment. J Am Geriatr Soc 2001; 49: 188–99

    Article  PubMed  Google Scholar 

  71. Weiner DK, Hanlon JT. Pain in nursing home residents: management strategies. Drugs Aging 2001; 18: 119–21

    Article  Google Scholar 

  72. Divoll M, Ameer B, Abernethy DR, et al. Age does not alter acetaminophen absorption. J Am Geriatr Soc 1982; 30: 240–4

    PubMed  CAS  Google Scholar 

  73. Wynne HA, Cope LH, Herd B, et al. The association of age and frailty with paracetamol conjugation in man. Age Aging 1990; 19: 419–24

    Article  CAS  Google Scholar 

  74. Ostapowicz G, Fontana RJ, Schiedt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. US Acute Liver Failure Study Group. Ann Intern Med 2002; 137: 947–54

    PubMed  Google Scholar 

  75. Donohoo E, managing editor. MIMS, issue no. 1. Sydney (NSW). CMPMedica Australia Pty Ltd, 2009 Feb/Mar

  76. Pearce B, Grant IS. Acute liver failure following therapeutic administration in patients with muscular dystrophies. Anaesthesia 2008; 63: 89–91

    Article  PubMed  CAS  Google Scholar 

  77. Dart RC, Bailey E. Does therapeutic use of acetaminophen cause acute liver failure? Pharmacotherapy 2007; 27: 1219–30

    Article  PubMed  CAS  Google Scholar 

  78. Schmidt LE. Age and paracetamol self-poisoning. Gut 2005; 54: 686–90

    Article  PubMed  CAS  Google Scholar 

  79. Myers RP, Li B, Fong A, et al. Hospitalizations for acetaminophen overdose: a Canadian population-based study from 1995 to 2004 [abstract]. BMC Pub Health 2007; 7: 143

    Article  Google Scholar 

  80. Farrell SE. Toxicity acetaminophen. Harvard Medical School, Department of Emergency Medicine, Brigham and Women’s Hospital [online]. Available from URL: http://www.emedicine.com/emerg/topic819.htm [Accessed 2008 Apr 14]

  81. Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly. Drugs Aging 2003; 20: 23–57

    Article  PubMed  CAS  Google Scholar 

  82. Brophy JM. Cardiovascular effects of cyclooxygenase-2 inhibitors. Curr Opin Gastroenterol 2007; 23: 617–24

    PubMed  CAS  Google Scholar 

  83. Bing RJ, Lomnicka M. Why do cyclo-oxygenase-2 inhibitors cause cardiovascular events? J Am Coll Cardiol 2002; 39(3) 521–2

    Article  PubMed  CAS  Google Scholar 

  84. Moore RA, Derry S, McQuay HJ. Cyclooxygenase-2 selective inhibitors and non-steroidal anti-inflammatory drugs: balancing gastrointestinal and cardiovascular risk [abstract]. BMC Musculoskelet Disord 2007; 8: 73

    Article  PubMed  Google Scholar 

  85. McGettigan P, Henry D. Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of observational studies of selective and non-selective inhibitors of cyclooxygenase-2. JAMA 2006; 296: 1633–44

    Article  PubMed  CAS  Google Scholar 

  86. McGettigan P, Han P, Jones L, et al. Selective COC-2 inhibitors, NSAIDs and congestive heart failure: differences between new and recurrent cases. Br J Clin Pharmacol 2008; 65: 927–34

    Article  PubMed  Google Scholar 

  87. Cunningham G, Dodd TRP, Grant DJ, et al. Drug-related problems in elderly patients admitted to Tayside hospitals: methods for prevention and subsequent reassessment. Age Aging 1997; 26: 375–82

    Article  CAS  Google Scholar 

  88. Larmour I, Dolphin RG, Baxter H, et al. A prospective study of hospital admissions due to drug reactions. Australian J Hosp Pharm 1991; 21: 90–5

    Google Scholar 

  89. Chan TYK, Critchley JAJH. Drug-related problems as a cause of hospital admissions in Hong Kong. Pharmacoepidemiol Drug Saf 1995; 4: 165–70

    Article  Google Scholar 

  90. Wilder-Smith OHG. Opioid use in the elderly. Eur J Pain 2005; 9: 137–40

    Article  PubMed  CAS  Google Scholar 

  91. Sullivan MD, Edlund MJ, Fan MY, et al. Trends in opioid use for non-cancer pain conditions 2000–2005 in commercial and Medicaid insurance plans: the Troup Study. Pain 2008; 138: 440–9

    Article  PubMed  Google Scholar 

  92. Kelly JP, Cook SF, Kaufman DW, et al. Prevalence and characteristics of opioid use in the US adult population. Pain 2008; 138: 507–13

    Article  Google Scholar 

  93. Langford R, McKenna F, Ratcliffe S, et al. Transdermal fentanyl for improvement of pain and functioning in osteoarthritis. Arth Rheum 2006; 54: 1829–37

    Article  CAS  Google Scholar 

  94. Ackerman SJ, Knight T, Schein J, et al. Risk of constipation in patients prescribed fentanyl transdermal system or oxycodone hydrochloride controlled-release in a California Medicaid population. Consult Pharm 2004; 19: 118–32

    Article  PubMed  Google Scholar 

  95. Otis J, Rothman M. A phase III study to assess the clinical utility of low-dose fentanyl transdermal system in patients with chronic non-malignant pain. Curr Med Res Opin 2006; 22: 14493–501

    Article  Google Scholar 

  96. Kung F, Gibson SJ, Helme RD. Factors associated with analgesic and psychotropic medications use by community-dwelling older people with chronic pain. Austral NZ J Pub Health 1999; 23: 471–4

    Article  CAS  Google Scholar 

  97. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007; (4): CD005454

  98. Neurology Expert Group. Therapeutic guidelines: neurology. Version 3. Melbourne (VIC): Therapeutic Guidelines Ltd, 2007

    Google Scholar 

  99. Wiffen P, Collins S, McQuay H, et al. Anticonvulsant drugs for acute and chronic pain. Cochrane Database Syst Rev 2005; (3): CD001133

  100. Schmader KE, Dworkin RH. Clinical features and treatment of postherpetic neuralgia and peripheral neuropathy in older adults. In: Gibson SJ, Weiner DK, editors. Pain in older persons. Seattle (WA): IASP Press, 2005: 355–75

    Google Scholar 

  101. Bernstein C, Lateef B, Fine P. Interventional pain management procedures in older patients. In: Gibson SJ, Weiner DK, editors. Pain in older persons. Seattle (WA): IASP Press, 2005: 263–83

    Google Scholar 

  102. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 298: 1107–16

    Article  Google Scholar 

  103. Cresswell KM, Fernando B, McKinstry B, et al. Adverse drug events in the elderly. Br Med Bull 2007; 83: 259–74

    Article  PubMed  CAS  Google Scholar 

  104. Kucukarslan SN, Peters M, Mlyarek M, et al. Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medical units. Arch Intern Med 2003; 163: 2014–8

    Article  PubMed  Google Scholar 

  105. Beney J, Bero LA, Bond C. Expanding the roles of outpatients pharmacists: effects on health services utilisation costs, and patient outcomes. Cochrane Database Syst Rev 2000; (2): CD000336

  106. O’Brien MA, Rogers S, Jamtvedt G, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007; (4): CD000409

  107. Smith DH, Perrin N, Feldstein A, et al. The impact of prescribing safety alerts for the elderly in an electronic medical record: an interrupted time series evaluation. Arch Intern Med 2006; 166: 1098–104

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The preparation of this manuscript was in part supported by a project grant from the National Health and Medical Research Council of Australia (# 285103) and a project grant from the Department of Health and Ageing, Australia (Evidence Based Practice in Residential Aged Care), both of which provide salary support for the authors. The authors have no other financial disclosures or conflicts of interest and do not receive any funding from the pharmaceutical industry.

Author information

Authors and Affiliations

  1. National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Parkville Carlton, Victoria, 3050, Australia

    Jonathan Bruce Barber & Stephen J. Gibson

Authors
  1. Jonathan Bruce Barber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen J. Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan Bruce Barber.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barber, J.B., Gibson, S.J. Treatment of Chronic Non-Malignant Pain in the Elderly. Drug-Safety 32, 457–474 (2009). https://doi.org/10.2165/00002018-200932060-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002018-200932060-00003

Keywords

Search

Navigation