• Wilco P Achterberg, Corinne M de Ruiter, Chantal M E E de Weerd-Spaetgens, Paul Geels, Annemieke Horikx, Monique M Verduijn, Verenso, LOC, Instituut Verantwoord Medicijngebruik, Nederlands Huisartsen Genootschap, Nederlandse Vereniging voor Klinische Geriatrie, Nederlandse Vereniging voor Psychiatrie, Nederlandse Vereniging voor Anesthesiologie, Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie, Verpleegkundigen en Verzorgenden Nederland, Nederlandse Vereniging voor Fysiotherapie in de Geriatrie, Ergotherapie Nederland, and Nederlands Instituut voor Psychologen.
• LUMC, afd. Public Health en Eerste lijnsgeneeskunde, Leiden, the Netherlands. w.p.achterberg@lumc.nl
• Ned Tijdschr Geneeskd. 2012 Jan 1;155(35):A4606.

AbstractChronic pain in vulnerable elderly people is still poorly recognized and treated, both at home and in hospitals and care and nursing homes. Vulnerable elderly people experience and express pain differently to relatively healthy adults, especially when they suffer from cognitive impairment or specific conditions. Determining the nature and severity of the pain requires the use of pain assessment instruments that have been validated for use in vulnerable elderly people. Effective treatment of pain demands careful diagnosis and pharmacological and non-pharmacological interventions that have proven effectiveness in vulnerable elderly people. The combination of multiple morbidity and poly-pharmacy increases the chance of side-effects and complications. In addition, the pharmacokinetic and pharmacodynamic characteristics of many drugs are different in vulnerable elderly people. The advice is to start with a lower dose of pain medication and gradually build up a level on the basis of pain relief and side-effects ('start low, go slow!').

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