331: Pain Management in Geriatric Patients (GeriPAIN): Results from an Evidence-based German Guideline

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

Background and Aims: Geriatric patients, characterized by advanced age, multimorbidity and increased overall vulnerability, experience an increased prevalence of pain. Cognitive impairment and communication barriers are also common and contribute to the underreporting of pain and challenges in pain recognition. Age-associated changes in metabolism and risk of adverse events limit the use of common analgesics, especially in long-term therapy and applicability of common non-pharmacological interventions is also compromised. To address these challenges, an evidence-based guideline was developed in Germany, providing interprofessional recommendations for pain management in geriatric patients across the primar healthcare, hospital and long-term care settings.

Methods: Interprofessional guideline development followed AWMF (Association of the Scientific Medical Societies in Germany) guidance and AGREEE criteria and was based on 15 key clinical questions. Recommendations were informed by a systematic literature search for systematic reviews and existing international guidelines. Recommendations were based on the best available evidence and supplemented with clinical experience where study results were lacking. A structured discussion and formal consensus process using nominal group technique with delegates from 33 scientific and medical societies and patient representatives completed guideline formulation. All recommendations were graded by evidence level using the Oxford classification (OCEBM) methodology.

Results: The guideline comprises 42 recommendations covering shared-decision making with geriatric patients with pain, continuity of care, pain assessment, general non-pharmacological interventions, general pharmacological interventions and disease-specific recommendations. Key recommendations emphasize integrating patients and informal caregivers into all aspects of pain management. Communication among health care professionals should be structured, and regular medication reviews are recommended. Pain assessment should begin with patient self-report, followed by a target group-specific hierarchical approach, including observational assessments for patients with cognitive impairment. Physical activity is strongly recommended for musculoskeletal pain. It was impossible to determine if any analgesic agent should be prioritized in geriatric patients.

Conclusions: A comprehensive guideline was developed that can guide doctors, physicians and allied-health professionals management of pain in geriatric patients. However, the evidence base for pain management in geriatric patients is generally lacking, due to exclusion from clinical trials or insufficient reporting. The applicability of many non-pharmacological interventions in patients with cognitive impairment needs to be investigated more thoroughly.

References: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - Ständige Kommission Leitlinien (Ed.) (2020): Das AWMF-Regelwerk Leitlinien. 2. Edition. AWMF
Brouwers, Melissa C.; Kho, M.; Browman, G. Cluzeau, F.; Feder, G.; Fervers, B.; Hanna, S.; Makarski, J. (2017): AGREE II: Advancing guideline development, reporting and evaluation in healthcare. AGREE Next Steps Consortium. Online: https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf [23.11.2022].
Deutsche Schmerzgesellschaft e.V.; Deutsche Gesellschaft für Geriatrie e.V.; UVSD SchmerzLOS e.V. (Ed.) (2025): S3-Leitlinie Schmerzmanagement bei Geriatrischen Patient:innen in allen Versorgungssettings (GeriPAIN). Langfassung 1.0 (AWMF-Registernummer 145/005), zuletzt geprüft am 09.01.2026.
OCEBM Levels of Evidence Working Group (Hg.) (2011): The Oxford 2011 Levels of Evidence. Online: http://www.cebm.net/index.aspx?o=5653 [16.02.2024].

Presenting Author: Melina Hendlmeier
Submitting Author: Thomas Fischer

Senior Author: Thomas Fischer

IASP 2026 Global Year theme of Neuropathic Pain: No

• Thomas Fischer: Prof. Dr. - ehs Dresden
• Erika Sirsch: Prof. Dr. - Universität Duisburg-Essen
• Corinna Drebenstedt: Dr. - St. Marienstift Friesoythe
• Heike Norda - SchmerzLOS e.V.
• Irmela Gnass: Prof. Dr. - PMU Salzburg
• Melina Hendlmeier: BSc., MSc. - Deutsche Schmerzgesellschaft e.V.