Pain Assessment and Management

As the general population ages, the proportion of older people requiring surgery is increasing. In contrast, postoperative pain is underestimated and therefore treated inadequately or ineffectively for cultural reasons. Awareness of the prevalence of pain in the elderly is critical because people older than 85 years represent the fastest growing segment of the population worldwide. Pain in the absence of disease is not a normal part of aging, yet it is experienced daily by most older people. Appropriate treatment of pain after surgery is essential to directly reduce postoperative morbidity and mortality, improving short- and long-term outcomes. The treatment of postoperative pain (POD) remains a major problem despite major advances in understanding the physiology of acute pain. The multimodal approach to multidisciplinary perioperative management, as outlined in the enhanced recovery after surgery (ERAS) protocols, includes for each type of surgery a series of interventions aimed at preservation and maintenance of preoperative organ function in order to reduce the surgical stress response and early discharge of the patient, resulting in improved outcomes and resource savings. The pain management begins preoperatively with the administration of pharmacological analgesics or the application of peripheral analgesia techniques, minimization of the surgical insult, and adequate postoperative analgesia allows early mobilization and rapid resumption.