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3. Reported frequency and intensity of acute pain in clinical situations may be reduced in
the older person (U) (Level III‐2).
4. Common unidimensional self‐report measures of pain can be used in the older patient in
the acute pain setting; in the clinical setting, the verbal descriptor and numerical rating
scales may be preferred (S) (Level III‐2).
5. Undertreatment of acute pain is more likely to occur in cognitively impaired patients (N)
(Level III‐2).
6. There is an age‐related decrease in opioid requirements; significant interpatient
variability persists (U) (Level IV).
SUMMARY 7. The use of nsNSAIDs and coxibs in older people requires extreme caution; paracetamol is
the preferred non‐opioid analgesic (U) (Level IV).
The assessment of pain and evaluation of pain relief therapies in the older patient may
present problems arising from differences in reporting, cognitive impairment and
difficulties in measurement (U).
Measures of present pain may be more reliable than past pain, especially in patients with
some cognitive impairment (U).
The physiological changes associated with ageing are progressive. While the rate of
change can vary markedly between individuals, these changes may decrease the dose
(maintenance and/or bolus) of drug required for pain relief and may lead to increased
accumulation of active metabolites (U).
The age‐related decrease in opioid requirements is related more to the changes in
pharmacodynamics that accompany aging than to the changes in pharmacokinetics (N).
Aboriginal and Torres Strait Islander peoples
1. The verbal descriptor scale may be a better choice of pain measurement tool than verbal
numerical rating scales (U) (Level III‐3).
2. Medical comorbidities such as renal impairment are more common in Aboriginal and
Torres Strait Islander peoples and New Zealand Maoris, and may influence the choice of
analgesic agent (U) (Level IV).
3. Clinicians should be aware that pain may be under‐reported by this group of patients (U)
(Level IV).
Communication may be hindered by social, language and cultural factors (U).
Provision of quality analgesia requires sensitivity to cultural practices and beliefs, and
behavioural expressions of pain (N).
Different ethnic and cultural groups
1. Disparities in assessment and effective treatment of pain exist across ethnic groups (N)
(Level III‐3).
Ethnic and cultural background can significantly affect the ability to assess and treat
acute pain (U).
Multilingual printed information and pain measurement scales are useful in managing
patients from different cultural or ethnic backgrounds (U).
xlvi Acute Pain Management: Scientific Evidence
