The elderly, particularly those 75 and older, often have multiple problems that are worsened by the presence of pain. The disability, dependence, and depression that often result require extensive time and energy from family and other caregivers, adding to the loss of self-worth. People of all ages with chronic pain have a 40 to 50 percent incidence of depression. Many elderly people also have chronic illnesses and less hope of recovery, which puts them at great risk for depression. People who have major clinical depression experience more pain because of deficits in the neurotransmitters serotonin and noradrenaline.
Untreated depression interferes with the ability to cope with stressors, including pain.
It has become more common to use antidepressants that increase serotonin and noradrenaline to treat chronic pain and depression. Although analgesic dosing studies rarely include patients over 65, one study showed that frail elderly men suffered less postoperative morbidity and mortality when aggressive pain relief was part of postoperative care. In orthopedic surgeries performed with local opioid premedication and nerve block, the patient's first request for pain medication occurs later than after surgery with general anesthesia alone. This is especially beneficial in the elderly, who are at greater risk for side effects from most analgesics. Patients who receive epidural narcotics or local anesthetics for pain relief before limb amputation for vascular insufficiency are less likely to develop phantom limb pain, compared to those receiving conventional treatment.