Pain
Pain in older people
Pain is common in residential aged care and easy to miss, particularly in people who cannot say they are hurting. This section explains how pain is recognised and assessed, and what the evidence shows about exercise, medicines, injections and procedures for the pain older people most often live with.
By Dr Josh Hatch, FRACGP
Where to start
Residents & families
Aged care staff
GPs & clinicians
All topics
Pain in aged care: how common, and why it is missed
What the studies show about how many residents live with pain, and why it often goes unrecognised
Assessing pain when a person cannot tell you
Observational pain tools such as PAINAD and the Abbey Pain Scale, what they can and cannot do, and what to ask
Persistent musculoskeletal pain: osteoarthritis and back pain
Common causes of long-term pain in older people, what the Australian care standards recommend, and when back pain needs a closer look
Non-drug treatments: exercise, physiotherapy, heat and other approaches
Each common approach, graded on randomised trials, with a note on how little of the evidence comes from aged care
Paracetamol and anti-inflammatory medicines
What paracetamol and anti-inflammatories offer older people, and the risks that matter in frailty
Opioids in older people: benefits, harms and deprescribing
What the trials show about opioids for long-term pain, the risks in frailty and dementia, and what is known about reducing them
Nerve pain and the gabapentinoids
What pregabalin and gabapentin offer for nerve pain, where they have not worked, and the risks when they are combined with opioids
Injections and other procedures: what the trials show
Joint injections, spinal injections, vertebroplasty and nerve ablation, described on the evidence, including the negative trials
Pain, dementia and changed behaviour
What the trials of treating pain show for agitation and low mood in dementia, and where the dementia section goes further
Pain: a guide for facility leadership
What Action 5.5.8 requires, how pain governance can be checked, and what the trials say about pain programs
No topics match that filter.
How the evidence is graded
Treatments are graded on randomised trial evidence for the outcome that matters: pain, function, behaviour or quality of life, weighed against harm. Trials in residential care are preferred. Many pain trials were done in people living at home who were younger than most residents, and that is labelled where it applies, with the average age where it was reported. Observational evidence is described and labelled. Numbers in the text link to the source they come from. Where the evidence is weak, conflicting or absent, that is stated. This section does not give doses, and it describes procedures on the evidence without recommending any procedure, clinic or practitioner.
- Supported by trial evidence Consistent randomised trial evidence of a benefit that matters.
- Promising, not yet proven A real signal, usually from a single trial, not yet confirmed.
- Uncertain / conflicting Trials conflict, or the evidence is too weak to say.
- Not supported Tested in adequate trials without showing a benefit.
- Risk outweighs benefit Evidence of net harm.
Last full evidence review: November 2026.