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Address correspondence to Thomas A. Cavalieri, DO, FACOI, Interim Dean, Professor and Director, New Jersey Institute for Successful Aging, University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine, One Medical Center Dr, Stratford, NJ 08084-1354. Dr Cavalieri has no conflicts of interest. E-mail: cavalita{at}umdnj.edu

The elderly are often untreated or undertreated for pain. Barriers to effective management include challenges to proper assessment of pain; underreporting by patients; atypical manifestations of pain in the elderly; a need for increased appreciation of the pharmacokinetic and pharmacodynamic changes of aging; and misconceptions about tolerance and addiction to opioids. Physicians can provide appropriate analgesia in geriatric patients by understanding different types of pain (nociceptive and neuropathic), and correctly using nonopioid, opioid, and adjuvant medications.

Opioids have become more widely accepted for treating older adults who have persistent pain, but such use requires physicians have an understanding of prevention and management of side effects, opioid titration and withdrawal, and careful monitoring. Placebo use is unwarranted and unethical. Nonpharmacologic approaches to pain management are essential and include osteopathic manipulative treatment, cognitive behavioral therapy, exercise, and spiritual interventions. The holistic and interdisciplinary approach of osteopathic medicine offers an approach that can optimize effective pain management in older adults.

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