Multidisciplinaire richtlijn ‘Herkenning en behandeling van chronische pijn bij kwetsbare ouderen’

Conflict of interest: none declared. Financial support: this guideline was drawn up with support of a subsidy from the Netherlands institute for health research and development ‘ZonMW’ (KKCZ project 150020039).

• Chronic 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!’).