Page 359 Guide to Pain Management in Low-Resource Settings

Clinical Physiology Pearls 347

are considered the standard of care at all ages. Special special observer-based scales have been developed
regimens apply, and most medications are being used and validated to allow assessment of pain and suff er-
off -label. ing in this vulnerable group. Th ere is some evidence
that the placebo eff ect is less effi cacious in demented
Insights on pain in people. Decline in liver and kidney function, on the
other hand, makes dosage adjustments necessary for
old age and dementia
many medications.
Pain thresholds and pain-evoked brain potentials have
Practical consequences
been studied in healthy volunteers up to the age of 100
years. Pain thresholds and evoked potential latencies Many people maintain normal functions of their no-
slightly increase and evoked potential amplitudes de- ciceptive system way into old age. When dementia is
crease at ages above 80 years. In many cases, however, present, pain assessment relies increasingly on the ob-
verbal communication skills may deteriorate in old age, servation of pain-related behavior. It is currently as-
with large individual variations. In this situation, pain sumed that the level of pain in demented patients is un-
assessment becomes diffi cult. For demented people, derestimated substantially.