Pain is not a normal part of ageing, and yet many older people are living with pain because of conditions they have developed in their later years or overall frailty.

In fact, various studies have estimated that between 45-80% of residents in aged care facilities have substantial pain that is undertreated.

The most obvious method of pain management is through pharmaceutical and drug therapies. In aged care, these often include the use of opioids. However, it’s important to consider other therapies as first line treatments, such as heat packs and massage.

For younger people, when it comes to pain management there are often concerns about dependence, addiction and the tolerance for the medication. Are these also concerns for older patients whose perception and tolerance of pain may be different to when they were younger? And what is the impact on the way pain medication is dispensed in aged care?

Physical Dependence

Physical dependence is when a person’s body has adapted to the persistent use of certain medications. If the medication were to be abruptly stopped or a “blocker” is given, it would lead to the person having a withdrawal syndrome.

Physical dependence does not only occur with pain medication, people can develop a dependence to other medications such as antidepressants and steroids.

Physical dependence is rarely a clinical issue – as long as continuity of use is maintained and then when ceasing the medication, this is done in a gradual manner.


Tolerance is when a person needs a higher dose of the medicine to maintain the same therapeutic effect.

It should be noted that for older people, only a low dosage of pain medication may be needed because they have a more rapid response to them and develop tolerance slower than younger people.

Tolerance to the different pharmacological effects of pain medication develops at different rates.

For example, tolerance to respiratory depression develops relatively rapidly. While tolerance to cognitive effects, sedation and nausea develops over several days and tolerance to constipation does not occur.


Addiction is often the most feared consequences of taking any strong pain medications.

Addiction is the pattern of continued use with the following behaviours; impaired control over drug use, compulsive use, continued use despite harm and cravings.

It is difficult to estimate the magnitude of the issue, however it is rare in patients with no previous history of drug or substance misuse.

However, it should be noted that older people are still at risk of experiencing addiction, in fact alcohol and prescription drug misuse affects up to 17 percent of older adults older than 60.

There is still a common misconception among the older generation that taking opioids may lead to “addiction” and therefore may be hesitant to accept pain medication.

There is often a belief that opioid therapy signals the end of life, but that comes from the fact that opioids historically have been used to help control pain in people with terminal illnesses.

However, when opioids are used at the lowest dose necessary to control pain and the patient is monitored, they do not hasten death – but rather provide the necessary symptom management.

ORBIS AU-4394 Feb18

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