16 - Sleep and pain management in the elderly

Summary

Pain management is increasingly recognized as a contributor to therapeutic effectiveness across a broad range of medical conditions in terms of improved outcomes and patient satisfaction. This chapter describes the nature of pain, epidemiology of non-malignant pain and comorbid sleep problems in older adults and the bidirectional relationship between sleep and pain. It presents the recommendations for evaluation and management of persistent, non-malignant pain drawn from evidence-based guidelines enhanced with emphasis on sleep. Pain has been associated with increased risk for depression, activity limitation or disability, polypharmacy, poorer quality of life, and increased healthcare utilization. Guidelines based on available evidence, supplemented with expert consensus, provide a framework for assessment and treatment of persistent pain in older adults. Optimal management strategies for the older adult with persistent pain include several goals such as identifying and treating primary sleep disorders, optimizing pain management and identification and treatment of psychiatric co-morbidities.