Age-related differences in pain perception and report

      The older person faces many threats to quality of life, including a marked increase in the incidence of disease, higher levels of functional disability, loss of lifetime partner or friends and family support networks, reductions in economic resources, and the foreboding prospect of institutional placement with an associated loss of independence. Even within this context, however, the presence of severe, unremitting pain is often regarded as one of the most common and devastating threats to health-related quality of life.
      • Kind P.
      • Dolan P.
      • Gudex C.
      • et al.
      Variations in population health status: Results from a United Kingdom national questionnaire survey.
      • Williams A.H.
      Recent epidemiologic studies indicate that more than 50% of older persons suffer from some form of persistent, bothersome pain complaint (see Helme and Gibson this volume for review). To provide adequate assessment and treatment for this ubiquitous problem, we need to clearly understand the extent and nature of any age-related change in pain perception and report. Unfortunately, attempts to address this issue have been somewhat sporadic, the results are often conflicting, and there remains a relative paucity of high-quality empirical investigations.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      PDF Download and 24 Hours Online Access
      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Clinics in Geriatric Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Albano W.
        • Zielinski C.M.
        • Organ C.H.
        Is appendicitis in the aged really different?.
        Geriatrics. 1975; 30: 8
        • Ambepitiya G.B.
        • Kopelman P.G.
        • Ingram D.
        • et al.
        Exertional myocardial ischaemia in diabetes: A quantitative analysis of anginal perceptual threshold and the influence of autonomic function.
        J Am Coll Cardiol. 1990; 15: 72
        • Ambepitiya G.B.
        • Iyengar E.N.
        • Roberts M.E.
        Silent exertional myocardial ischaemia and perception of angina in elderly people.
        Age Aging. 1993; 22: 302
        • Ambepitiya G.
        • Roberts M.
        • Ranjadayalan K.
        • et al.
        Silent exertional myocardial ischemia in the elderly: A quantitative analysis of anginal perceptual threshold and the influence of autonomic function.
        J Am Geriatr Soc. 1994; 42: 732
        • Bellville J.W.
        • Forrest W.H.
        • Miller E.
        • et al.
        Influence of age on pain relief from analgesics: A study of postoperative patients.
        JAMA. 1971; 217: 1835
        • Benbow S.
        • Cossins L.
        • Bowsher D.
        A comparison of young and elderly patients attending a regional pain centre.
        Pain Clin. 1995; 8: 323
      1. Benbow S, Cossins L, Wiles JR: A comparative study of disability, depression and pain severity in young and elderly chronic pain patients [abstract 238a]. In Abstracts 8th World Congress on Pain, 1996 p 289

        • Bender J.S.
        Approach to the acute abdomen.
        Med Clin North Am. 1989; 73: 1413
        • Benesch L.S.
        • Szigeti E.
        • Ferraro F.R.
        • et al.
        Tools for assessing chronic pain in rural elderly women.
        Home HealthCare Nurse. 1997; 15: 207
        • Besson J.M.
        • Chaouch A.
        Peripheral and spinal mechanisms of nociception.
        Physiol Rev. 1987; 67: 67
        • Birren J.E.
        • Schapiro H.B.
        • Miller J.H.
        The effect of salicylate upon pain sensitivity.
        J Pharmacol, Exp Ther. 1950; 100: 61
        • Bodnar R.J.
        • Romero M.T.
        • Kramer E.
        Organismic variables and pain inhibition: Roles of gender and aging.
        Brain Res Bull. 1988; 21: 947
        • Botwinick J.
        Aging and Behavior. Springer Publishing Company, New York1984
        • Brescia F.J.
        • Adler D.
        • Gray G.
        • et al.
        Hospitalized advanced cancer patients: A profile.
        J Pain Symptom Manage. 1990; 5: 221
        • Brescia F.J.
        • Portenoy R.K.
        • Ryan M.
        • et al.
        Pain, opioid use, and survival in hospitalized patients with advanced cancer.
        J Clin Oncol. 1992; 10: 149
        • Butler R.N.
        • Gastel B.
        Care of the aged: Perspectives on pain and discomfort.
        in: Ng L.K. Bonica J. Pain, Discomfort and Humanitarian Care. Elsevier, New York1980: 297
        • Caraceni A.
        • Portenoy R.K.
        • et al.
        An international survey of cancer pain characteristics and syndromes.
        Pain. 1999; 82: 263
        • Carboni G.P.
        • Lahiri A.
        • Cashman P.M.
        • et al.
        Ambulatory heart rate and ST-segment depression during painful and silent myocardial ischemia in chronic stable angina pectoris.
        Am J Cardiol. 1987; 59: 1029
        • Cauna N.
        The effects of aging on the receptor organs of the human dermis.
        Adv Biol Skin. 1965; 6: 63
        • Cervero F.
        Sensory innervation of the viscera: Peripheral basis of visceral pain.
        Physiol Rev. 1994; 74: 95
        • Chakour M.
        • Gibson S.J.
        • Helme R.D.
        The effect of age on A delta and C fibre thermal pain perception.
        Pain. 1996; 64: 143
        • Chapman W.P.
        Measurements of pain sensitivity in normal control subjects and in psychoneurotic patients.
        Psychosom Med. 1944; 6: 252
        • Chapman B.W.
        • Jones C.M.
        Variations in cutaneous and visceral pain sensitvity in normal subjects.
        J Clin Invest. 1944; 23: 81
        • Cherng C.H.
        • Ho S.T.
        • Kao S.J.
        • et al.
        The study of cancer pain and its correlates.
        Ma Tsui Hseuh Tsa Chi. 1991; 29: 653
        • Clark W.C.
        • Mehl L.
        Thermal pain: A sensory decision theory analysis of the effect of age and sex on d', various response criteria, and 50% pain threshold.
        J Abnorm Psychol. 1971; 78: 202
        • Clinch D.
        • Banjeree A.K.
        • Ostick G.
        Absence of abdominal pain in elderly patients with peptic ulcer.
        Age Aging. 1984; 13: 120
        • Clouse R.E.
        • Abramson B.K.
        • Todorczuk J.R.
        Achalasia in the elderly. Effects of aging on clinical presentation and outcome.
        Dig Dis Sci. 1991; 36: 225
        • Coleman J.A.
        • Denham M.J.
        Perforation of peptic ulceration in the elderly.
        Age Ageing. 1980; 9: 257
        • Collins L.G.
        • Stone L.A.
        Pain sensitivity, age and activity level in chronic schizophrenics and in normals.
        Br J Psychiatr. 1966; 112: 33
        • Coppola R.
        • Gracely R.H.
        Where is the noise in SDT pain assessment?.
        Pain. 1983; 17: 257
        • Corran T.M.
        • Gibson S.J.
        • Farrell M.J.
        • et al.
        Comparison of chronic pain experience between young and elderly patients.
        in: Progress in Pain Research and Management. vol 2. IASP Press, Seattle, WA1994: 895
        • Corran T.M.
        • Helme R.D.
        • Gibson S.J.
        The classification of elderly patients with chronic pain.
        Clin J Pain. 1997; 13: 207
        • Corso J.F.
        Aging Sensory Systems and Perception. Praeger, New York1981
        • Critchley M.
        The neurology of old age.
        Lancet. 1931; 225: 1221
        • Curless R.
        • French J.M.
        • Williams G.V.
        • et al.
        Colorectal carcinoma: Do elderly patients present differently?.
        Age Ageing. 1994; 23: 102
        • Cutler R.B.
        • Fishbain D.A.
        • Rosomoff R.S.
        • et al.
        Outcomes in treatment of pain in geriatric and younger age groups.
        Arch Phys Med Rehabil. 1994; 75: 457
        • D'Antono B.
        • Ditto B.
        • Rios N.
        • et al.
        Risk for hypertension and diminished pain sensitivity in women: Autonomic and daily correlates.
        Int J Psychophysiol. 1999; 31: 175
        • Duggleby W.
        • Lander J.
        Cognitive status and post operative pain: Older adults.
        J Pain Sympt Manage. 1994; 9: 19
        • Esposito A.L.
        Community-acquired bacteremic pneumococcal pneumonia. Effect of age on manifestations and outcome.
        Arch Intern Med. 1984; 144: 945
        • Ferrell B.A.
        • Ferrell B.R.
        • Osterweil D.
        Pain in the nursing home.
        J Am Geriatr Soc. 1990; 38: 409
        • Ferrell B.A.
        Pain evaluation and management in the nursing home.
        Ann Intern Med. 1995; 123: 681
        • Gagliese L.
        • Melzack R.
        Chronic pain in elderly people.
        Pain. 1997; 70: 3
        • Gagliese L.
        • Melzack R.
        Age differences in the quality of chronic pain: A preliminary study.
        Pain Res Manage. 1997; 2: 157
        • Gagliese L.
        • Katz J.
        • Melzack R.
        Pain in the elderly.
        in: Wall P.D. Melzack R. Textbook of Pain. Churchill Livingstone, New York1999: 991
      2. Gagliese L, Wowk A, Sandler A, et al: Pain and opioid self-administration following prostatectomy in middle-aged and elderly men [abstract 185]. In Abstracts 9th World Congress on Pain, Vienna, 1999, p 558

        • Ghione S.
        Hypertension-associated hypalgesia. Evidence in experimental animals and humans, pathophysiological mechanisms, and potential clinical consequences.
        Hypertension. 1996; 28: 494
        • Gibson S.J.
        • Gorman M.M.
        • Helme R.D.
        Assessment of pain in the elderly using event related cerebral potentials.
        in: Bond M.R. Charlton J.E. Woolf C.J. Proceedings of the VIth World Congress on Pain. Elsevier, Amsterdam1991: 527
        • Gibson S.J.
        • Le Vasseur S.A.
        • Helme R.D.
        Cerebral event-related responses induced by CO2 laser stimulation in subjects suffering from cervico-brachial syndrome.
        Pain. 1991; 47: 173
        • Gibson S.J.
        • Katz B.
        • Corran T.M.
        • et al.
        Pain in older persons.
        Disabil Rehabil. 1994; 16: 127
        • Gibson S.J.
        • Littlejohn G.O.
        • Helme R.D.
        • et al.
        Altered heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in subjects with fibromyalgia syndrome.
        Pain. 1994; 58: 185
        • Gibson S.J.
        • Granges G.
        • Littlejohn G.O.
        • et al.
        Increased thermal pain sensitivity in patients with fibromyalgia syndrome.
        Advan Pain Res Therap. 1995; 22: 401
        • Gibson S.J.
        • Helme R.D.
        Age differences in pain perception and report: A review of physiological, psychological, laboratory and clinical studies.
        Pain Rev. 1995; 2: 111
        • Gibson S.J.
        • Farrell M.
        • Katz B.
        • et al.
        Multidisciplinary management of chronic non-maligant pain in older adults.
        in: Ferrell B.R. Ferrell B.A. Pain in the Elderly. IASP Press, Seattle, WA1996: 91
        • Gibson S.J.
        Measurement of mood states in elderly adults.
        J Gerontol. 1997; 52B: 167
        • Gibson S.J.
        • Helme R.D.
        Cognitive factors and the experience of pain and suffering in older persons.
        Pain. 2000; 85: 375
        • Gracely R.H.
        Subjective quantification of pain perception.
        in: Bromm B. Neurophysiological Correlates of Pain. Elsevier Science Publishers BV, Amsterdam1984: 371
        • Gracely R.H.
        Pain psychophysics.
        in: Advances in Pain Research and Therapy. vol 12. Raven Press, New York1989: 211
        • Green DM Swets J.A.
        Signal Detection Theory and Psychophysics. Wiley, New York1966
        • Grove G.L.
        Physiologic changes in older skin.
        Clin Geriatr Med. 1989; 5: 115
        • Guasti L.
        • Cattaneo R.
        • Rinaldi O.
        • et al.
        Twenty-four-hour noninvasive blood pressure monitoring and pain perception.
        Hypertension. 1995; 25: 1301
        • Guasti L.
        • Zanotta D.
        • Petrozzino M.R.
        • et al.
        Relationship between dental pain perception and 24 hour ambulatory blood pressure: A study on 181 subjects.
        J Hypertens. 1999; 17: 1799
        • Gullo L.
        • Sipahi H.M.
        • Pezzilli R.
        Pancreatitis in the elderly.
        J Clin Gastroenterol. 1994; 19: 64
        • Hall K.R.L.
        • Stride E.
        The varying response to pain in psychiatric disorders: A study in abnormal psychology.
        Br J Med Psychiatry. 1954; 27: 48
        • Hamm R.J.
        • Knisely J.S.
        Environmentally-induced analgesia: An age-related decline in a neurally-mediated, nonopioid system.
        Psychol Aging. 1986; 1: 195
        • Hamm R.J.
        • Knisely J.S.
        • Watson A.
        Environmentally-induced analgesia: Age related differences in a hormonally-mediated, nonopioid system.
        J Gerontol. 1986; 41: 336
        • Hardy J.D.
        • Wolff H.G.
        • Goodell H.
        The pain threshold in man.
        An J Psychiatr. 1943; 99: 744
        • Harkins S.W.
        • Chapman C.R.
        Detection and decision and factors in pain perception in young and elderly men.
        Pain. 1976; 2: 253
        • Harkins S.W.
        • Chapman C.R.
        Age and sex differences in pain perception.
        in: Anderson B. Matthews B. Pain in the Trigeminal Region. Elsevier Press, Amsterdam1977: 435
        • Harkins S.W.
        • Chapman C.R.
        The perception of induced dental pain in young and elderly women.
        J Gerontol. 1977; 32: 428
        • Harkins S.W.
        • Warner M.H.
        Age and pain.
        in: Eisdorfer C. Annual Review of Gerontology and Geriatrics. Springer Publishing Company, New York1980: 121
        • Harkins S.W.
        • Kwentus J.
        • Price D.D.
        Pain and the elderly.
        in: Benedetti C. Chapman C.R. Moricca G. Advances in Pain Research and Therapy, vol 7. Raven Press, New York1984: 103
        • Harkins S.W.
        • Price D.D.
        • Martelli M.
        Effects of age on pain perception: Thermonociception.
        J Gerontol. 1986; 41: 58
        • Harkins S.W.
        Pain in the elderly.
        in: Dubner R. Gebhart G.F. Bond M.R. Procedings of the Vth World Congress on Pain. Elsevier Science, Amsterdam1988: 355
      3. Harkins SW, Dougherty L, Colenda C, et al: Chronic pain: Adult age effects. [abstract 15]. In Abstracts 5th World Congress on Pain, 1990, p S10

        • Harkins S.W.
        • Kwentus J.
        • Price D.D.
        Pain and suffering in the elderly.
        in: Bonica J. Management of Pain. Lea and Febiger, Philadelphia1990: 552
        • Harkins S.W.
        • Price D.D.
        • Bush F.M.
        • et al.
        Geriatric pain.
        in: Wall P.D. Melzack R. Textbook of Pain. Churchill Livingstone, New York1994: 769
        • Harkins S.W.
        Geriatric pain: Pain perceptions in the old.
        Clin Geriatr Med. 1996; 12: 435
        • Harkins S.W.
        • Davis M.D.
        • Bush F.M.
        • et al.
        Suppression of first pain and slow temporal summation of second pain in relation to age.
        J Gerontol. 1996; 51A: 260
        • Harkins S.W.
        • Price D.D.
        • Bush F.M.
        • et al.
        Geriatric pain.
        in: Wall P.D. Melzack R. Textbook of Pain. ed 3. Churchill Livingstone, New York1996: 769
        • Heft M.W.
        • Cooper B.Y.
        • O'Brien K.K.
        • et al.
        Aging effects on the perception of noxious and non-noxious thermal stimuli applied to the face.
        Aging Clin Exp Res. 1996; 8: 35
        • Helme R.D.
        • Corran T.M.
        • Gibson S.J.
        Pain in the elderly.
        Proc Aust Assoc Gerontol. 1992; 27: 22
        • Helme R.D.
        • Gibson S.J.
        Pain in the elderly.
        in: Jensen T.S. Turner J.A. Wiesenfeld-Hallin W. Progress in Pain Research and Management, vol 8. WA IASP Press, Seattle1997: 919
        • Helme R.D.
        • Gibson S.J.
        Measurement and management of pain in older people.
        Aust J Ageing. 1998; 17: 5
        • Herr K.A.
        • Mobily P.
        Comparison of selected pain assessment tools for use with the elderly.
        Appl Nurs Res. 1993; 6: 39
        • Herr K.A.
        • Mobily P.R.
        • Kohout F.J.
        • et al.
        Evaluation of the faces pain scale for use with the elderly.
        Clin J Pain. 1998; 14: 29
        • Horch K.
        • Hardy M.
        • Jimenez S.
        • et al.
        An automated tactile tester for evaluation of cutaneous sensibility.
        J Hand Surg. 1992; 17A: 829
        • Hunt T.E.
        Pain and the aged patient.
        in: Smith W.L. Mersky H. Gross S.C. Pain: Meaning and Measurement. SP Medical & Scientific, New York1980: 143
        • Jensen M.P.
        • Karoly P.
        • Braver S.
        The measurement of clinical pain intensity: A comparison of six methods.
        Pain. 1986; 27: 117
        • Jensen R.
        • Rasmussen B.K.
        • Pedersen B.
        • et al.
        Cephalic muscle tenderness and pressure pain threshold in a general population.
        Pain. 1992; 48: 197
        • Kaminer M.S.
        • Gilchrest B.A.
        Aging of the skin.
        in: Hazzard W.R. Bierman E.L. Blass J.P. Principles of Geriatric Medicine and Gerontology. ed 3. McGraw Hill, New York1994: 411
        • Kenshalo D.R.
        Age changes in touch, vibration, temperature, kinesthesis and pain sensitivity.
        in: Birren J.E. Schaie K.W. Handbook of the Psychology of Aging. Van Nostrand Rienhold Company, New York1977: 562
        • Kenshalo D.R.
        Changes in the vestibular and somesthetic systems as a function of age.
        in: Ordy J.M. Brizzee K.R. Sensory Systems and Communication in the Elderly. Raven Press, New York1979: 269
        • Kenshalo D.R.
        Somesthetic sensitivity in young and elderly humans.
        J Gerontol. 1986; 41: 732
        • Kind P.
        • Dolan P.
        • Gudex C.
        • et al.
        Variations in population health status: Results from a United Kingdom national questionnaire survey.
        BMJ. 1998; 316: 736
        • Konu V.
        Myocardial infarction in the elderly.
        Acta Med Scand. 1977; 9: 604
        • Kramer E.
        • Bodnar R.J.
        Age-related decrements in the analgesic response to cold water swims.
        Physiol Behav. 1986; 36: 875
        • Laitinen L.V.
        • Eriksson A.T.
        Electrical stimulation in the measurement of cutaneous sensibility.
        Pain. 1985; 22: 139
        • Lasch H.
        • Castell D.O.
        • Castell J.A.
        Evidence for diminished visceral pain with aging: Studies using graded intraesophageal balloon distension.
        Am J Physiol. 1997; 272: G1
        • Lautenbacher S.
        • Strian F.
        Similarities in age differences in heat pain perception and thermal sensitivity.
        Funct Neurol. 1991; 6: 129
        • Lichtenberg P.A.
        • Skehan M.W.
        • Swensen C.H.
        The role of personality, recent life stress and arthritic severity in predicting pain.
        J Psychosom Res. 1984; 28: 231
        • Liou J.T.
        • Lui P.W.
        • Lo Y.L.
        • et al.
        Normative data of quantitative thermal and vibratory thresholds in normal subjects in Taiwan: Gender and age effect.
        Chin Med J. 1999; 62: 431
        • Liston R.
        • McLoughlin R.
        • Clinch D.
        Acute pneumothorax: A comparison of elderly with younger patients.
        Age Ageing. 1994; 23: 393
        • Lucantoni C.
        • Marinelli S.
        • Refe A.
        • et al.
        Course of pain sensitivity in aging: Pathogenetical aspects of silent cardiopathy.
        Arch Gerontol Geriatr. 1997; 24: 281
        • Lusiani L.
        • Perrone A.
        • Pesavento R.
        • et al.
        Prevalence, clinical features, and acute course of atypical myocardial infarction.
        Angiology. 1994; 45: 49
        • MacDonald J.B.
        • Ballie J.
        • Williams B.O.
        • et al.
        Coronary care in the elderly.
        Age Ageing. 1983; 12: 17
      4. McCraken LM, Mosely TH, Plaud JJ, et al: Age, chronic pain and impairment: Results from two clinical samples [abstract 286]. In Abstracts 7th World Congress on Pain, 1993, p 99

        • McMillan S.C.
        The relationship between age and intensity of cancer related symptoms.
        Oncol Nurs Forum. 1989; 16: 237
        • Meh D.
        • Denislic M.
        Quantitative assessment of thermal and pain sensitivity.
        J Neurol Sci. 1994; 127: 164
      5. Meier DE, Morrison RS, Ahronheim JC, et al: Quantifying pain and discomfort from procedures in hospitalized patients: validation of a new tool [abstract 123]. In Proceedings of the American Geriatric Society, 1996, p 127

      6. Meliala A, Gibson SJ, Helme RD: The effect of stimulation site on detection and pain thresholds in young and older adults [abstract 188]. In Abstracts 9th World Congress on Pain, Vienna, 1999, p 559

        • Melzack R.
        • Katz J.
        The McGill Pain Questionnaire: Appraisal and current status.
        in: Turk D.C. Melzack R. Handbook of Pain Assessment. Guilford Press, New York1994: 152
        • Mertz H.
        • Fullerton S.
        • Naliboff B.
        • et al.
        Symptoms and visceral perception in severe functional and organic dyspepsia.
        Gut. 1998; 42: 814
        • Meyer R.A.
        • Campbell J.N.
        • Raja S.N.
        Peripheral neural mechanisms of nociception.
        in: Wall P.D. Melzack R. Textbook of Pain. Churchill Livingstone, New York1994: 13
        • Middaugh S.J.
        • Levin R.B.
        • Kee W.G.
        • et al.
        Chronic pain: Its treatment in geriatric and younger patients.
        Arch Phys Med Rehabil. 1988; 69: 1021
        • Miller P.F.
        • Sheps D.S.
        • Bragdon E.E.
        • et al.
        Aging and pain perception in ischemic heart disease.
        Am Heart J. 1990; 120: 22
        • Morin C.
        • Lund J.P.
        • Villarroel T.
        • et al.
        Differences between the sexes in post-surgical pain.
        Pain. 2000; 85: 79
        • Morrison R.S.
        • Ahronheim J.C.
        • Morrison G.R.
        • et al.
        Pain and discomfort associated with common hospital procedures and experiences.
        J Pain Symptom Manage. 1998; 15: 91
      7. Mosley TH, McCracken LM, Gross RT, et al: Age, pain, and impairment: Results from two clinical samples [abstract 286]. In Abstract 7th World Congress on Pain, 1993, p 99

        • Muller R.T.
        • Gould L.A.
        • Betzu R.
        • et al.
        Painless myocardial infarction in the elderly.
        Am Heart J. 1990; 119: 202
        • Mumford J.M.
        Pain perception threshold and adaptation of normal human teeth.
        Arch Oral Biol. 1965; 10: 957
        • Mumford J.M.
        Pain perception in man on electrically stimulating the teeth.
        in: Soulairac A. Cahn J. Charpentier J. Pain. Academic Press, London1968: 224
        • Neri M.
        • Agazzani E.
        Aging and right-left asymmetry in experimental pain measurement.
        Pain. 1984; 19: 43
        • Norman D.C.
        • Yoshikawa T.T.
        Intra-abdominal infections in the elderly.
        J Am Geriatr Soc. 1983; 31: 677
        • Notermans S.L.H.
        Measurement of pain threshold determined by electrical stimulation and its clinical application. Part I. Method and factors possibly influencing the pain threshold.
        Neurology. 1966; 16: 1071
        • Oberle K.
        • Paul P.
        • Wry J.
        • et al.
        Pain, anxiety and analgesics: A comparative study of elderly and younger surgical patients.
        Can J Ageing. 1990; 9: 13
        • Ohnmeiss D.D.
        • Guyer R.D.
        • Mason S.L.
        The relation between cervical discographic pain responses and radiographic images.
        Clin J Pain. 2000; 16: 1
        • Page G.D.
        • France C.R.
        Objective evidence of decreased pain perception in normotensives at risk for hypertension.
        Pain. 1997; 73: 173
        • Parker J.
        • Frank R.
        • Beck N.
        • et al.
        Pain in rheumatoid arthritis: Relationship to demographic, medical and psychological factors.
        J Rheumatol. 1988; 15: 433
        • Pathy M.S.
        Clinical presentation of myocardial infarction in the elderly.
        Heart. 1967; 29: 190
        • Politser P.
        • Schneidman D.
        American College of Surgeons: Socioeconomic Factbook for Surgery 1990. American College of Surgeons, Chicago1990
        • Price D.D.
        • Hu J.W.
        • Dubner R.
        • et al.
        Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses.
        Pain. 1977; 3: 57
        • Procacci P.
        A study of the cutaneous pricking pain threshold in normal man.
        in: Soulairac A. Cahn J. Charpentier J. Pain. Academic Press, London1968: 223
        • Procacci P.
        • Bozza G.
        • Buzzelli G.
        • et al.
        The cutaneous pricking pain threshold in old age.
        Geronto Clin. 1970; 12: 213
        • Procacci P.
        Methods for the study of pain threshold in man.
        in: Bonica J.J. Liebeskind J.C. Albe-Fessard D.G. Advances in Pain Research and Therapy, vol 3. Raven Press, New York1979: 781
        • Rodstein M.
        The characteristics of non-fatal myocardial infarction in the aged.
        Arch Intern Med. 1956; 98: 684
        • Rollman G.B.
        Signal detection theory measurement of pain: A review and critique.
        Pain. 1977; 3: 187
        • Rosen S.D.
        • Paulesu E.
        • Nihoyannopoulos P.
        • et al.
        Silent ischemia as a central problem: Regional brain activation compared in silent and painful myocardial ischemia.
        Ann Intern Med. 1996; 124: 939
        • Scapa E.
        • Horowitz M.
        • Waron M.
        • et al.
        Duodenal ulcer in the elderly.
        J Clin Gastroenterol. 1989; 11: 502
        • Scapa E.
        • Horowitz M.
        • Avtalion J.
        • et al.
        Appreciation of pain in the elderly.
        Isr J Med Sci. 1992; 28: 94
        • Schobel H.P.
        • Handwerker H.O.
        • Schmieder R.E.
        • et al.
        Effects of naloxone on hemodynamic and sympathetic nerve responses to pain in normotensive vs. borderline hypertensive men.
        J Auton Nerv Syst. 1998; 69: 49
        • Schulderman E.
        • Zubek J.P.
        Effect of age on pain sensitivity.
        Percep Motor Skills. 1962; 14: 295
        • Schumacher G.A.
        • Goodell H.
        • Hardy J.D.
        • et al.
        Uniformity of the pain threshold in man.
        Science. 1940; 92: 110
      8. Scudds RJ, Scudds RA: A comparison of hot and cold pain thresholds between young subjects and young-elderly, middle-elderly and old-elderly subjects [abstract 194]. In Abstracts 9th World Congress on Pain, Vienna, 1999, p 560

        • Sherman E.D.
        • Robillard E.
        Sensitivity to pain in the aged.
        Can Med Assoc J. 1960; 83: 944
        • Sherman E.D.
        • Robillard E.
        Sensitivity to pain in relationship to age.
        J Am Geriatr Soc. 1964; 12: 1037
        • Simone D.A.
        • Sorkin L.S.
        • Oh U.
        • et al.
        Neurogenic hyperalgesia: Central neural correlates in response of spinothalamic tract neurons.
        J Neurophysiol. 1989; 66: 228
        • Solomon C.G.
        • Lee T.H.
        • Cook E.F.
        • et al.
        Comparison of clinical presentation of acute myocardial infarction in patients older than 65 years of age to younger patients: The multicenter chest pain study experience.
        Am J Cardiol. 1989; 63: 772
        • Sorkin B.A.
        • Rudy T.E.
        • Hanlon R.B.
        • et al.
        Chronic pain in old and young patients: Differences appear less important than similarities.
        J Gerontol. 1990; B45: 64
        • Stein W.M.
        Cancer pain in the elderly.
        in: Ferrell B.R. Ferrell B.A. Pain in the Elderly. IASP Press, Seattle, WA1996: 69
        • Thomas T.
        • Robinson C.
        • Champion D.
        • et al.
        Prediction and assessment of the severity of post operative pain and of satisfaction with management.
        Pain. 1998; 75: 177
        • Thould A.K.
        Coronary heart disease in the aged.
        BMJ (London). 1965; 2: 1089
        • Tinker G.M.
        Clinical presentation of myocardial infarction in the elderly.
        Age Ageing. 1981; 10: 237
        • Torebjork H.E.
        • Lundberg L.E.
        • La Motte R.H.
        Central changes in processing of mechanoreceptive input in capsaicin-induced secondary hyperalgesia in humans.
        J Physiol (Lond). 1992; 448: 765
      9. Tremblay N, Allard N, Veillette Y: Effect of age on pain perception: Preliminary results [abstract 283]. In Abstracts 7th World Congress on Pain, 1993, p 98

        • Tremblay N.
        Douleurs du Viellard: Revue des connaissances actuelles.
        in: Roy D.J. Rapin C.H. Collection Amaryllis. Institute de reserche Clinique de Montreal, Montreal1994: 99
        • Tresch D.D.
        • Brady W.J.
        • Aufderheide T.P.
        • et al.
        Comparison of elderly and younger patients with out-of-hospital chest pain: Clinical characteristics, acute myocardial infarction, therapy, and outcomes.
        Arch Intern Med. 1996; 156: 1089
        • Tucker M.A.
        • Andrew M.F.
        • Ogle S.J.
        • et al.
        Age-associated change in pain threshold measured by transcutaneous neuronal electrical stimulation.
        Age Ageing. 1989; 18: 241
        • Turk D.C.
        • Okifuji A.
        • Scharff L.
        Chronic pain and depression: Role of perceived impact and perceived control in different age cohorts.
        Pain. 1995; 61: 93
        • Umachandran V.
        • Ranjadayalan K.
        • Ambepitiya G.B.
        • et al.
        Ageing, autonomic function and the perception of angina.
        Br Heart J. 1991; 66: 15
        • Vigano A.
        • Bruera E.
        • Suarex-Almazor M.E.
        Age, pain intensity, and opioid dose in patients with advanced cancer.
        Cancer. 1998; 83: 1244
        • Walsh N.E.
        • Schoenfeld L.
        • Ramamurthy S.
        • et al.
        Normative model for cold pressor test.
        Am J Phys Med Rehab. 1989; 68: 6
        • Washington L.J.
        • Gibson S.J.
        • Helme R.D.
        Age-related differences in endogenous analgesia to repeated cold water immersion in human volunteers.
        Pain. 2000; 89: 89
        • Wilkieson C.A.
        • Madhok R.
        • Hunter J.A.
        • et al.
        Toleration, side-effects and efficacy of sulphasalazine in rheumatiod arthritis patients of different ages.
        Q J Med. 1993; 86: 501
        • Williams A.H.
        The measurement and valuation of health: A chronicle. Centre for Health Economics, University of York, England1995
        • Woodrow K.M.
        • Friedman G.D.
        • Siegelaub A.B.
        • et al.
        Pain tolerance: Differences according to age, sex and race.
        Psychosom Med. 1972; 34: 548
        • Wroblewski M.
        • Mikulowski P.
        Peritonitis in geriatric inpatients.
        Age Ageing. 1991; 20: 90
        • Yarnitsky D.
        • Sprecher E.
        • Zaslansky R.
        • et al.
        Heat pain thresholds: Normative data and repeatability.
        Pain. 1995; 60: 329
        • Yehuda S.
        • Carasso R.
        A brief history of pain perception and pain tolerance in aging.
        in: Mostofsky D.L. Lomranz J. Handbook of Pain and Aging. Plenum Press, New York1997: 10
        • Yunus M.B.
        • Holt G.S.
        • Masi A.T.
        • et al.
        Fibromyalgia syndrome among the elderly: Comparison with younger patients.
        J Am Geriatr Soc. 1988; 36: 987
        • Zheng Z.
        • Gibson S.J.
        • Helme R.D.
        • et al.
        Age-related differences in the development of capsaicin-induced hyperalgesia.
        Pain. 2000; 85: 51