Pain Management for Older Adults Across the Cognitive Trajectory.

Purpose of review: This review investigated current research on the relationship between chronic pain and cognitive performance, subjective cognitive decline, and dementia. In addition, we reviewed current research on pain management in older adults across the cognitive trajectory. Recent findings: Chronic pain remains a common problem in older adults. A new, international classification system highlights the complexity of chronic pain syndromes. Research supports relationships between chronic pain and changes in cognitive performance in generally healthy adults. Evidence also supports associations between pain and subjective cognitive decline, which is considered a possible precursor to dementia. The impact of dementia on pain expression is also reviewed. To manage pain in older adults, we present a multimodal pain management hierarchy that includes pharmacological and non-pharmacological treatments. To avoid the risks and side effects of analgesics, non-pharmacological treatment is recommended as the first line therapy for chronic pain. Medical cannabis and music therapy are two non-pharmacological treatments that have been the focus of substantial recent research; evidence supports their effectiveness in reducing pain and both strategies warrant further investigation. Summary: Chronic pain is associated with different levels of cognitive decline across the cognitive trajectory. Medical cannabis and music therapy are the two emerging non-pharmacological treatment methods. Clinical studies with rigorous research design are needed to further investigate the effects of these two strategies on pain relief in older adults.