Pain management in older patients and renal impairment
Assessing pain in older people including those with dementia (Abbey and PAINAD), paracetamol, NSAIDs and opioids adjusted for frailty and kidney function, which opioids to avoid in CKD and dialysis, gabapentinoid dose limits by creatinine clearance, Beers 2023 cautions, and worked dosing examples.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Pain is under-recognised and under-treated in older people, most of all in dementia, where it shows as agitation, refusing care, reduced mobility or delirium.
- Assess before prescribing: self-report works in mild to moderate dementia; use the Abbey Pain Scale or PAINAD when it doesn't.
- Older people have less muscle mass, lower renal clearance and higher brain sensitivity. Start low, go slow, but titrate to effect.
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Sources
- Therapeutic Guidelines: Pain and AnalgesiaAU/NZTherapeutic Guidelines Limited, 2024
- PS01(PM) Appendix 2: Opioid dose equivalenceAU/NZFaculty of Pain Medicine, Australian and New Zealand College of Anaesthetists, October 2025
- Acute Pain Management: Scientific Evidence (5th edition)AU/NZANZCA and Faculty of Pain Medicine, 2020
- Opioid Analgesic Stewardship in Acute Pain Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2022
- American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults (J Am Geriatr Soc 2023;71:2052-81)American Geriatrics Society, 2023
- The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia (Abbey J et al. Int J Palliat Nurs 2004;10:6-13)AU/NZInternational Journal of Palliative Nursing, 2004
- Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale (Warden V et al. J Am Med Dir Assoc 2003;4:9-15)Journal of the American Medical Directors Association, 2003
- Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial (Husebo BS et al. BMJ 2011;343:d4065)BMJ, 2011
- Last updated
- 14 November 2026
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