RT Journal
A1 Kempen P
T1 MAnaging pain in elderly patients
JF JAMA
JO JAMA
YR 1999
FD February 17
VO 281
IS 7
SP 605
OP 606
DO 10-1001/pubs.JAMA-ISSN-0098-7484-281-7-jbk0217
UL http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-281-7-jbk0217
AB 
Pain is not always constant or somatic, and while often readily
mitigated, cannot always be eliminated or prevented for many
physiological, pharmacodynamic, personal, and psychological reasons.
All effective medications have adverse effects, many of which are
significant and some potentially deadly. Indeed, patients with cancer
have daily pain, as the goal is typically to weigh risk vs benefit of
medications to afford the best quality of life possible, often limited
to tolerable pain. Even general anesthesia does not eliminate pain, as
clearly autonomic evidence of pain is routinely detectable during
surgery. Only the experience of pain is effectively suppressed. For
treatment of acute pain, suppression of consciousness is logical and
useful, but cannot be the goal in chronic pain states, as conscious
experience of events is central to quality of life. Increasing pain
associated with progressive disease vs obtundation of consciousness is
a stark reality for individuals at life's end.