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4 References 1. Dieleman JP et al. Incidence rates and treatment of neuropathic pain conditions in the general po- pulation. Pain, 2008, 137: 681-688. 2. Langley P. The prevalence, correlates and treat- ment of pain in the European Union. Curr Med Res Opin, 2011, 27: 463-480. 3. Cooner E et al. The study of pain and older Ame- ricans. New York, Harris 1997. 4. Murray CJ, Lopez AD. Global burden of disease study. Lancet, 1997, 348: 1498-1504. 5. Köhler G et al. Drug-drug interactions in medical patients: effects of in-hospital treatment and re- lation to multiple drug use. Int J Clin Pharmacol Ther, 2000, 38:504-513. 6. Herr K. Clin Pain assessment in older adults. J Pain, 2004, 20: 207-219. 7. malignant disease increasing with age, the majority of patients recei- ving opioid treatment are between 50 and 90 years of age4 . Drug interactions Most elderly persons are taking some form of prescription medica- tion and many are taking a consi- derable number of different drugs. A study in Germany revealed the extent of this problem5 . An expo- nential relationship exists between the probability of drug interactions and the number of drugs prescri- bed. Prescribing fewer drugs could have the benefit of reducing the risk of suffering from sickness due to secondary drug interaction. Improving pain treatment in the elderly Since most pain treatment studies have been conducted in young adult populations, the degree to which standardised treatments need to be modified to meet the specific needs of the older patient has not been well studied. However, there are a number of different approa- ches that may prove beneficial. For diagnosis, Verbal Pain Scales (e.g. none, weak etc.) seem to be pre- ferred by older people rather than Visual Analogue Scales6 . A Pain- vision computer system is being developed in Belgium which recog- nises facial expressions that are in- dicative of pain, which would be of particular benefit in cases where communication skills are limited7 . A “start low go slow” approach to therapeutic treatment may be of benefit in elderly patients, allowing the patient’s body systems time to gradually adapt to the medica- tion and giving physicians time to monitor the development of any adverse drug effects. The Plan-Do- Study-Act model of quality impro- vement which encourages careful evaluation of treatment outcome followed by modification of initial treatment as necessary has been shown to raise the standard of pain management in nursing homes. Aimed at reducing dispensing and drug administration errors, techni- ques such as computerised prescri- bing and point-of-care systems may provide safety benefits along with the adoption of anonymous error-reporting systems. In order to capitalise on the poten- tial benefits of improved treatment there needs to be better teaching of pain medicine, particularly with regard to the use of opioids, both at the undergraduate and postgra- duate level. Conclusions Successful treatment of pain in older persons requires a multidisci- plinary approach that encompasses medicines, physical and comple- mentary therapies combined with psychological and social interven- tions adapted to specific needs. A number of different approaches to pain care in the elderly have been identified which take into account the declining physiological and psychological function associated with increasing age. Put into prac- tice by better trained physicians, it is expected that these approaches should bring about improved pain management in the older patient. DRUG PRESCRIPTION TO ELDERLY MEDICAL PATIENTS IN TWO GERMAN UNIVERSITY HOSPITALS, 1997–985 N = 169 No.ofpatients No. of drugs prescribed 35 30 25 20 15 10 5 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14