Treating cancer and no-cancer pain in older and oldest old patients

Pain is one of the most frequent reasons for consultations in general practice, presenting either alone or associated with some comorbidity. In all care settings for older and oldest old patients, a gap exists between best-practice recommendations and current clinical practice. Clinical manifestations of persistent pain are often complex and multifactorial in the frail population, so the approach to pain management in older persons differs from that for younger people. The purpose of this review is to describe the best approach to assess and manage persistent cancer and no-cancer pain in the elderly, to explain the principles of pain treatment in this so often frail and complex population and compare the different drugs that should be used or avoided in older and oldest old patients considering the agerelated physiologic changes. Considerable emphasis is placed on conditions more common in the elderly such as neuropathic pain or typical subsets of the aging population such as the assessment of pain in people with dementia.