Regarding the management of pain in older people,1 GPs are often advised to avoid opioids. This is not realistic for many patients, especially those who have taken opioids long term.

It should always be considered, in any age group, whether there is an appropriate procedure that may help, such as injections, radio frequency and joint surgeries. In addition, many patients who complain of pain are also depressed (as opposed to the many who have depression but do not complain) so treating depression (including options such as transcranial magnetic stimulation and ECT) always needs to be considered. A generalised chronic pain syndrome can occur in the elderly and mental health is key.

Pain management programs should also not exclude the elderly. It is important to avoid therapeutic nihilism in the elderly and at least think of all the options that may be offered to younger people.

Sarah Abrahamson

Rehabilitation physician, Victorian Rehabilitation Centre, Glen Waverley, Vic.


Author's response

Gloria Wong, the author of the article, comments:

The article focused on the pharmacological management of chronic non-cancer pain in the elderly. While non-pharmacological and interventional approaches were outside the scope of the article, they are nevertheless important in the holistic care of the elderly. The article contained some references for readers interested in these interventions.

The article highlighted the importance of a balanced, evidence-based approach, with careful consideration of the risks associated with pharmacotherapy in older people with chronic pain. ‘Choosing wisely’ is by no means nihilistic.


The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by any responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Sarah Abrahamson

Rehabilitation physician, Victorian Rehabilitation Centre, Glen Waverley, Vic.

Gloria Wong

General medicine and Clinical pharmacology registrar, Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital

Lecturer, Faculty of Medicine, University of Queensland, Brisbane