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Acute pain management in older adults presenting to the emergency department: a clinical review
Author(s)
Kampan, Sirasa
Thong-On, Kwannapa
Pongvirat, Kanokporn
Veeraditthakij, Monalin
Sri-On, Jiraporn
Date Issued
April 1, 2026
Type
Review
Abstract
ABSTRACT: Managing acute pain in older adults is a complex challenge in emergency care, influenced by age-related physiological changes, multimorbidity and altered pharmacokinetics. Inadequate treatment contributes to frailty, delirium, functional decline and reduced quality of life, yet oligoanalgesia remains prevalent. Accurate assessment is essential, using tools such as the numeric rating scale, Pain Assessment in Advanced Dementia and Abbey Pain Scale, according to cognitive status. Treatment prioritises acetaminophen as first-line therapy, with cautious use of nonsteroidal anti-inflammatory drugs and opioids, following the 'start low, go slow' principle. Alternative options, including intranasal or nebulised ketamine and methoxyflurane, as well as regional anaesthesia techniques such as pericapsular nerve group and serratus anterior plane blocks, offer additional benefits. A multimodal, individualised approach is essential to achieve safe and effective pain control in this vulnerable population.
Citation
Singapore Medical Journal, 67(4), 211-223, 2026