Version May 2024
| Patient factors | Considerations when prescribing analgesic medication |
| Medical comorbidities | |
| Constipation | For most patients, prescribe a stimulant laxative (eg, senna) when opioids are initiated. |
| Lower extremity edema, hypertension, congestive heart failure, peptic ulcer disease, renal insufficiency | These conditions may be exacerbated by nonsteroidal antiinflammatory drugs. Gabapentin and pregabalin can contribute to lower extremity edema. Renal insufficiency may influence use of and dosing of various analgesics. |
| Obesity | Some medications (eg, gabapentin, pregabalin, tricyclic antidepressants) may contribute to weight gain. |
| Sleep disturbance | Pain may disrupt sleep. Opioids are associated with disruption in sleep architecture. |
| Difficulty walking/falls | Pain may contribute to weakness, difficulty walking, and falls. Patients with underlying mobility problems should be monitored carefully when medications that may cause balance and mobility problems (eg, opioids, pregabalin, gabapentin, tricyclic antidepressants) are prescribed. Ongoing ascertainment of benefit and risk is critical. |
| Memory loss | Pain may contribute to poorer neuropsychological performance. Although effective pain treatment may improve memory, some pain medications (eg, opioids, pregabalin, gabapentin, tricyclic antidepressants) may contribute to confusion. Ongoing assessment of benefits and risks is critical. |
| Psychological factors | |
| Depression, anxiety | Underlying depression and/or anxiety can impair neuropsychological performance. These issues should be treated as part of pain treatment. |
| Coping skills | Poor coping skills (eg, tendency to catastrophize) can inhibit the efficacy of pain treatment. Patients who do not cope well with chronic pain may benefit from cognitive behavioral therapy (CBT) as part of pain treatment. |
| Fear of movement (fear-avoidance beliefs) | Patients with a history of falls may fear recurrent falls and thus may be reluctant to be mobile. Fear avoidance beliefs (ie, fear of moving because of concerns about exacerbating pain) can be reduced by physical therapy. Referral to a pain psychologist also may be helpful. |
| Treatment expectancy | Patients who believe that treatment will work will likely improve (placebo effect); those who believe that treatment will not work tend not to improve (nocebo effect). |
| Social factors | |
| Social/caregiver support | Social isolation can interfere with the older adult's ability to distract themselves from their pain and thus intensify the pain experience. This may be especially problematic for the older adult with dementia. |
| Financial status | Patients without the financial resources to access recommended treatments will not use them. |
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