277: Pain Assessment in Geriatric Patients: An International Guideline Synopsis and Evidence Gap Analysis

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Clinical Practice Guidelines (CPGs) provide systematically developed, evidence-based, and consensus-driven recommendations to support clinical decision-making. Although many CPGs address pain management, few specifically focus on pain assessment in geriatric populations, despite frequent cognitive impairment and communication barriers that complicate pain recognition. Within the development of the German guideline “Pain Management in Geriatric Patients,” [1] we conducted a guideline synopsis to compare and synthesize international recommendations on this topic. This contribution focuses on the clinical question: “How can information about pain be obtained in geriatric patients?”, emphasizing international differences and gaps in recommendations for clinical practice and future guideline development.

Methods: We conducted a systematic search for guidelines in the G-I-N (Guidelines International Network) database, complemented by forward citation tracking in 2022 and updated in 2026. Two independent researchers evaluated the identified guidelines using the AGREE II Instrument [2] to assess methodological quality. All recommendations relevant to our research question were extracted, along with any linked evidence. In a second step, we performed a comparative thematic analysis to identify consistencies, divergences, and gaps among international recommendations, with particular attention to conceptual approaches to pain assessment, methodological rigor, and the strength of the evidence supporting specific recommendations.

Results: We identified six guidelines on pain management and over 30 recommendations explicitly addressing pain assessment in older adults. Most lacked a systematic link between recommendations and evidence, relying primarily on expert consensus. A recurring theme was that pain assessment should begin with self-report when possible, using patients’ own language, and supplemented by observational tools for those with cognitive impairment [3,4,5,6,7,8]. No guidelines endorsed a single validated tool for geriatric use. Several advised assessing pain both at rest and during movement, yet all lacked supporting empirical evidence.

Conclusions: Despite recurring recommendations across guidelines, robust evidence supporting pain assessment methods in geriatric patients remains scarce. The lack of randomized controlled trials may stem from the inherent complexity of assessing pain as a multifactorial, subjective experience. Traditional evidence hierarchies may be insufficient for this context. Future research should adopt complex intervention frameworks integrating quantitative and qualitative data to better capture real-world clinical dynamics.

References: 1. Deutsche Schmerzgesellschaft e.V., Deutsche Gesellschaft für Geriatrie e.V., UVSD SchmerzLOS e.V. (Hrsg.) (2025): S3-Leitlinie Schmerzmanagement bei Geriatrischen Patient:innen in allen Versorgungssettings (GeriPAIN). AWMF-Register-Nr. 145/005. Version 1.0.

2. Brouwers MC, Kho M, Browman, G. Cluzeau, F. et al. (2017) AGREE II: Advancing guideline development, reporting and evaluation in healthcare

3. Bons, S., Borg, M., van den Donk, M., Koes, B., Kuijpers, T., Ostelo, R., et al. (2017). Aspecifieke lagerugpijn [Non-specific low back pain]. Retrieved from https://richtlijnen.nhg.org/files/pdf/13_Aspecifieke%20lagerugpijn_februari-2017.pdf

4. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI). (2021). Behandlung akuter perioperativer und posttraumatischer Schmerzen. Retrieved from https://register.awmf.org/assets/guidelines/001-025l_S3_Behandlung-akuter-perioperativer-posttraumatischer-Schmerzen_2022-11.pdf

5. Damen, Z., Kadir-Klevering, F., Keizer, D., Luiten, W., van den Donk, M., Van’t Klooster, S., et al. (2021). Pijn [Pain]. Retrieved from https://richtlijnen.nhg.org/files/pdf/31_Pijn_november-2021.pdf

6. Paice, J. A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., Citron, M., et al. (2016). Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 34(27), 3325–3345. https://doi.org/10.1200/JCO.2016.68.5206

7. The Australian Pain Society (Ed.). (2019). Pain in residential aged care facilities: Management strategies (2nd ed.): The Australian Pain Society.

8. Verenso (Ed.). (2016). Multidisciplinaire richtlijn pijn: Herkenning en behandeling van pijn bij kwetsbare ouderen (Deel 1–3). Retrieved January 10, 2023, from https://www.verenso.nl/_asset/_public/Richtlijnen_kwaliteit/richtlijnen/database/VER-003-32-Richtlijn-Pijn-deel2-v5LR.pdf

Presenting Author: Melina Hendlmeier
Submitting Author: Melina Hendlmeier

Senior Author: Thomas Fischer

IASP 2026 Global Year theme of Neuropathic Pain: No

• Erika Sirsch: Prof. Dr. rer. medic. MScN, RN - University Duisburg-Essen, Institut für Didaktik in der Medizin
• Evelyn Gebhardt: MSc, RN - University Duisburg-Essen, Institut für Didaktik in der Medizin
• Corinna Drebenstedt: Dr. med. - St.Marien-Hospital
• Heike Norda: NA - Independent Association of Active Pain Patients in Germany (UVSD SchmerzLOS e.V.)
• Thomas Fischer: Prof. Dr. rer. cur., MPH - Evangelische Hochschule Dresden (ehs) – University for Applied Sciences for Social Work, Education and Nursing