Pain in Older People Across Viet Nam’s Care Continuum: From Recognition and Assessment to Safe, Function-Focused and Person-Centred Management

AGE-FRIENDLY CARE QUALITY & LONG-TERM CARE QUALITY

Last reviewed: October 2026

An older person may stop walking as far as they used to, begin sleeping in a chair because getting into bed hurts, or decline rehabilitation because every movement has become uncomfortable. Someone living with dementia may not say “I am in pain” at all. They may become restless, withdraw from others, resist being moved or suddenly eat and sleep less. Another person may continue taking pain medicine prescribed months ago, add an over-the-counter product recommended by someone they know and never mention either during a clinic visit. In each situation, pain is doing more than causing discomfort. It is influencing movement, independence, medication safety, caregiving and the person's ability to participate in everyday life.

Pain is common in later life, but it should not be accepted as an inevitable consequence of aging. The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. It also emphasizes that pain is a personal experience influenced to varying degrees by biological, psychological and social factors, and that verbal description is only one way in which pain may be expressed. An inability to communicate does not mean that pain is absent. Chronic pain, generally understood as pain that persists or recurs for more than three months, can become an important clinical problem in its own right because of its effects on function, emotional well-being and participation.

For older people, the question should therefore not simply be “How severe is the pain?” A more useful set of questions is: “What may be causing this pain? What is it stopping this person from doing? What matters most to them? And can we reduce its impact without creating new harm?”

Pain is both a symptom and a functional problem

Pain can signal acute illness or injury, accompany conditions such as osteoarthritis, fracture, neuropathy or cancer, or persist long after an initial injury has healed. Different pain mechanisms may coexist in the same person, which is one reason two older people with apparently similar diagnoses can experience very different levels of discomfort and disability.

That distinction matters because management should respond to the nature of the problem rather than simply to a number on a pain scale. Musculoskeletal pain may require a different approach from neuropathic pain; acute postoperative pain is different from long-standing back pain; cancer-related pain raises different priorities again. A burning, shooting or electric quality may suggest a neuropathic component, while pain closely linked to movement around an arthritic joint may point toward a predominantly musculoskeletal pattern. These descriptions can help guide assessment, but they do not replace clinical evaluation.

Function is particularly important in later life. Pain may make someone walk less, avoid stairs, stop cooking, sleep poorly or become dependent on another person for bathing or dressing. Reduced activity can then contribute to weakness, deconditioning and loss of confidence. Pain leads to less movement; less movement can make functional recovery harder; and increasing dependency may in turn make pain more difficult to manage.

Vietnamese evidence illustrates this relationship. A study published in 2025, using data collected from November 2019 to March 2020, examined 518 people aged 60 years and older with chronic pain attending the outpatient department of the National Geriatric Hospital. Participants with moderate-to-severe pain had substantially higher odds of dependency in both activities of daily living and instrumental activities of daily living than those with milder pain. Because everyone in the study already had chronic pain and attended a specialized geriatric outpatient service, the findings do not establish national prevalence. They do, however, provide important Vietnamese evidence linking pain severity with functional dependence.

What does Vietnamese evidence actually tell us?

Viet Nam does not yet have one contemporary national estimate that accurately describes chronic pain among all older people across different care settings. Available studies come mainly from hospital and specialist populations, so their findings need to be interpreted within those settings rather than converted into national prevalence figures.

In the National Geriatric Hospital study, the knee, leg and foot region was among the most commonly reported sites of chronic pain. Just over half of the study population was classified as having moderate-to-severe pain at assessment, and the relationship between greater pain severity and functional dependency remained significant after adjustment for other factors. That proportion should not be interpreted as meaning that more than half of all older Vietnamese people have moderate-to-severe chronic pain; the study population had already been selected because participants had chronic pain.

A study published in 2026 examined 240 people aged 60 years and older diagnosed with chronic pain and treated at Military Hospital 103 between August 2025 and April 2026. Mean pain intensity was 6.22 out of 10; 50.83% of participants had moderate pain and 44.58% had severe pain. Neuropathic and mixed pain patterns were among the characteristics associated with severe pain. Again, this was a selected hospital population composed entirely of people already diagnosed with chronic pain. It tells us about pain characteristics in that population, not how common chronic pain is among older people across Viet Nam.

Another 2026 study involved 289 hospitalized adults aged 60 years and older with chronic pain at a general hospital in Da Nang. Some 92.7% reported having used at least one complementary or alternative medicine modality, and biologically based approaches, including herbal products, were the most commonly reported category. This striking figure should not be generalized to all older Vietnamese people because it comes from one selected hospital population. Its practical message is nevertheless important: a medication and treatment history is incomplete if clinicians ask only about prescription medicines.

The most defensible conclusion is therefore not that Viet Nam has one established prevalence of chronic pain in older age. It is that Vietnamese studies already document substantial pain-related needs and functional consequences in selected older populations, while nationally representative evidence spanning community, hospital, home and long-term care remains limited.

Viet Nam has a practical foundation for recognizing pain, but not a stand-alone geriatric pain guideline

Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 provides a useful Vietnamese foundation for recognizing pain within older-person care at home and in the community. Pain is explicitly considered when assessing factors that may affect mobility. The guidance notes that substantial movement-related pain can limit or even prevent exercise and that assessing its severity can help both with pain management and with planning appropriate physical activity.

The guidance also addresses pain in common musculoskeletal conditions. In relation to osteoarthritis, it advises older people with substantial pain to seek appropriate clinical assessment and cautions against the use of analgesics of unclear origin and the overuse of pain medicines.

This is highly relevant in Viet Nam, where a person's actual pain-management regimen may include medicines prescribed by several clinicians, medicines purchased directly from pharmacies, previous prescriptions kept at home, traditional-medicine products, herbal preparations or treatments recommended by relatives and acquaintances. Decision 1976/QĐ-BYT should not, however, be described as a comprehensive national clinical guideline for geriatric pain management. It is broader professional guidance for caring for older people at home and in the community. Determining why someone is in pain and deciding whether they need medication, rehabilitation, investigation, an intervention or specialist referral still require appropriate clinical assessment.

Circular No. 34/2026/TT-BYT of 8 September 2026 gives Decision 1976 additional implementation relevance. Its provisions on community care for older people direct relevant training materials and capacity-building activities for health and population personnel, community workers, volunteers, older people and caregivers to use the professional guidance in Decision 1976. This creates a pathway through which principles such as recognizing movement-related pain, supporting safe physical activity and strengthening caregiver capability can become part of wider community-based older-person care. Circular 34 itself is not a pain-management guideline.

Internationally, WHO's 2024 Long-term care for older people: package for universal health coverage reinforces the broader principle that long-term care should integrate health interventions, rehabilitation, palliation, caregiving and social support rather than fragmenting them into disconnected services. WHO also makes clear that the package is primarily intended for governments and policy-makers planning long-term care systems; it is not a bedside clinical guideline, standard operating procedure or step-by-step manual.

Recognition and assessment should change care

Good pain care begins with noticing that pain may be present. Some older people describe pain readily. Others under-report it because they believe it is simply part of aging, do not want to burden their family, fear tests or medicines, or have lived with discomfort for so long that they no longer mention it unless someone asks.

The wording of the question can matter. Instead of asking only “Are you in pain?”, it may be useful to ask about aching, soreness, burning, discomfort or what is making movement difficult. Whenever a person can communicate their own experience reliably, self-report should remain central. Assessment should go beyond intensity to consider where the pain is, when it began, whether it is constant or intermittent, how it feels, what makes it better or worse, what treatments have already been tried and whether neurological or systemic symptoms are present.

New pain should not automatically be attributed to “old age.” Sudden severe pain, pain after a fall or other trauma, severe chest or abdominal pain, a hot swollen joint accompanied by systemic illness, new neurological weakness, or new back pain associated with major neurological or bladder or bowel changes may signal conditions requiring urgent assessment. Fracture, infection, cancer, vascular disease and other serious causes need to remain in the differential diagnosis when the clinical picture warrants it.

For older people, function deserves as much attention as intensity. Is pain preventing the person from getting out of a chair, walking to the bathroom, sleeping through the night, preparing food or participating in rehabilitation? Have they stopped leaving the house? Are they avoiding movement because it hurts, or because they fear that movement will cause more damage?

The question “What would you like to be able to do that pain is preventing you from doing?” may sometimes reveal more than another numerical rating.

Assessment also needs to be repeated. Pain after surgery may change quickly. Neuropathic pain may evolve more slowly. An older person's tolerance of treatment may change after acute illness, deterioration in kidney function, delirium or a fall. A plan that made sense last month may not make sense today.

A useful pathway is:

recognition → multidimensional assessment → individualized management → functional reassessment → adjustment.

A pain score without action is documentation, not pain management.

Pain in dementia needs a different kind of attention

Cognitive impairment should never be interpreted as protection from pain. Many people living with mild or moderate dementia can still describe pain, particularly when questions are simple, enough time is allowed and communication is adapted to the individual. As dementia progresses, self-report may become less reliable or no longer feasible for some people, and additional approaches are then needed.

Changes in facial expression, vocalization, guarding, body movement, sleep, appetite, social interaction or usual behavior may provide clues. New agitation or resistance to washing, dressing, repositioning or transfers can have many possible causes—including delirium, fear, environmental stress and other unmet needs, but pain should be considered rather than immediately treating the behavior itself as the primary problem.

Structured observational tools such as PAINAD, PACSLAC, MOBID-2 and related instruments can support assessment when verbal communication is limited. They are not diagnostic tests and should not replace clinical judgment. Observation may be particularly informative during movement and everyday care because some pain becomes visible only when the person stands, transfers, walks, dresses or is repositioned.

Family members and regular care workers can contribute information that no score captures. A daughter who says, “He has stopped using his right arm when getting dressed,” or a care worker who notices that a resident cries out only during transfers may be providing clinically important information.

The principle is simple: absence of a verbal pain complaint is not evidence of absence of pain.

The goal is better living, not simply a lower number

For chronic pain, complete elimination of pain may not always be realistic. That does not mean care has failed. A more meaningful goal may be for someone to walk safely to the bathroom, return to physiotherapy, sleep more comfortably, sit through a family meal, resume gardening or reduce reliance on a medicine that makes them dizzy.

Pain intensity matters, but meaningful improvement may first appear in function, confidence and participation. This approach also reduces the temptation to chase progressively lower pain scores with progressively more burdensome treatment.

The American Geriatrics Society's 2025 companion guidance to the Beers Criteria reinforces this perspective by identifying improvement in function as an important goal of pain management and by emphasizing non-pharmacological approaches for chronic pain, either alone or together with appropriately selected medicines depending on the pain mechanism and clinical context.

The older person's priorities should shape those decisions. One person may accept some remaining discomfort because staying alert and independent matters most. Someone experiencing severe postoperative pain may temporarily accept stronger analgesia so that they can breathe deeply, mobilize and participate in rehabilitation. A person receiving palliative care may place comfort above considerations that would dominate treatment in another setting.

Person-centered pain management therefore asks what outcome matters to the person rather than assuming that everyone has the same objective.

Movement can be part of treatment, but only when movement is made possible

Pain and movement have a complicated relationship. Severe pain can make physical activity difficult or frightening, while prolonged inactivity can contribute to weakness, stiffness, deconditioning and dependency. Good pain management often aims not to eliminate every painful sensation before movement begins, but to make meaningful and safe activity possible.

Depending on the underlying condition, management may involve physiotherapy, graded activity, strength and balance work, positioning, joint protection, occupational therapy, pacing, appropriate assistive products, psychological interventions or other non-pharmacological approaches. The right strategy depends on diagnosis, function, risk and the person's circumstances.

Telling every older person with pain simply to “exercise more” is not individualized care. Someone with an unrecognized fracture, acute inflammatory condition or unstable medical problem needs assessment before exercise progression. Someone afraid of falling may need supervised rehabilitation. A person whose walking aid is poorly fitted may need an equipment review rather than more encouragement.

Decision 1976/QĐ-BYT is particularly relevant here because it directly connects assessment of movement-related pain with planning appropriate physical activity for older people.

The practical question becomes: What movement matters to this person, and what needs to change so that they can do it as safely and comfortably as reasonably possible?

Medication safety matters as much as analgesic effectiveness

Pain medicines can be highly valuable, but they can also create new problems if treatment is not matched to the older person's physiology, diseases and wider medication regimen. Older people are more likely to live with renal or hepatic impairment, cardiovascular and gastrointestinal disease, cognitive impairment, frailty, falls risk and polypharmacy. A treatment strategy that is straightforward in a younger adult may therefore require considerably more caution in later life.

There is no single “best pain medicine for older people.” Drug selection should reflect the cause and likely mechanism of pain, severity, duration, comorbidities, kidney and liver function, concurrent medicines, previous treatment response and the person's priorities.

Systemic non-steroidal anti-inflammatory drugs can be effective for selected musculoskeletal conditions, but chronic use in older adults can increase gastrointestinal, renal and cardiovascular risks. Particular caution is needed when NSAIDs are combined with anticoagulants, antiplatelet drugs or systemic corticosteroids. The 2023 AGS Beers Criteria advise against chronic use of non-selective NSAIDs in many older adults unless alternatives are ineffective and appropriate risk-mitigation measures are possible. Because the Beers Criteria were developed specifically for the United States and apply to adults aged 65 years and older, they should be used in Viet Nam as an international clinical reference rather than as a substitute for Vietnamese prescribing requirements or individualized clinical judgment.

For some localized pain conditions, topical agents may offer a more favorable adverse-effect profile than systemic treatment and can be considered when clinically appropriate. Neuropathic pain may require a different pharmacological approach, and some medicines used for neuropathic pain can themselves cause dizziness, sedation, gait instability or other adverse effects and may require dose adjustment when renal function is impaired.

Opioids require the same balance between adequate relief and avoidable harm. They can have an appropriate role in severe acute pain, cancer-related pain, palliative care and selected other situations. Older people, however, may be particularly susceptible to constipation, sedation, confusion, delirium, falls, drug interactions and respiratory depression.

A multidisciplinary clinical consensus published in 2026 on opioid treatment for chronic pain in older adults reinforces the need for individualized prescribing, conservative initiation and titration, regular reassessment and proactive management of adverse effects. It also emphasizes that cancer pain and chronic non-cancer pain are different clinical contexts. For chronic non-cancer pain, other appropriate approaches should be optimized, the risk–benefit balance should be considered carefully and, when opioids are used, treatment should have a clear therapeutic purpose and an ongoing review plan rather than continuing indefinitely without reassessment.

Vietnamese legal requirements also matter. Where an opioid is classified as a narcotic medicine under Vietnamese law, prescribing and dispensing must comply with the applicable controlled-medicine requirements. For outpatient treatment, Circular No. 26/2025/TT-BYT contains specific requirements for prescribing narcotic medicines, including the relevant prescription and documentation processes. International guidance can inform clinical reasoning, but it does not replace Vietnamese legal and professional obligations.

Medication review should therefore ask two questions at the same time: “Is this treatment reducing pain enough to matter?” and “What is this treatment costing the person in alertness, balance, bowel function, cognition, appetite or independence?”

A medicine can lower a pain score and still make overall care worse.

Traditional, complementary and self-directed pain care needs to be part of the conversation

Pain management in Viet Nam needs to reflect what people actually do, not only what appears on the hospital medication list. Older people may use massage, acupuncture, traditional medicine, herbal preparations, topical products, supplements or other complementary approaches alongside conventional medical treatment.

The 2026 Da Nang study is a reminder of why clinicians should ask directly. In that selected hospitalized chronic-pain population, 92.7% of participants reported using at least one complementary or alternative medicine modality. The finding should not be generalized nationally, but it makes one practical point difficult to ignore: asking only about prescribed analgesics may leave a substantial part of the person's actual treatment invisible.

These conversations should be respectful. Traditional medicine is a recognized area of health care in Viet Nam, and the safety issue is not simply whether something is described as “traditional” or “natural.” Relevant questions include what the person is using, whether its source and composition are known, whether it is being provided or used within an appropriately regulated or professional context, what evidence exists for the particular indication, whether it duplicates another treatment and whether interactions or delayed clinical assessment could create harm.

Dismissive conversations can make people less willing to disclose what they use. Uncritical acceptance creates a different risk. Safe person-centered care requires an accurate picture of everything the person is actually taking or doing for pain.

Hospitals, rehabilitation services and care transitions need one coherent pain plan

Acute pain in hospital is not only about comfort; it can directly affect recovery. An older person with inadequately controlled postoperative pain may avoid deep breathing, coughing, standing or participating in physiotherapy. Severe pain can contribute to distress, sleep disruption and functional decline. Excessive analgesic treatment, however, can cause drowsiness, impaired mobility, delirium, falls, drug interactions or respiratory complications.

Pain therefore needs to be assessed together with the response to treatment. If the pain score falls but the person becomes so sedated that they cannot mobilize, the outcome is not necessarily good. If they remain alert but pain is severe enough to prevent rehabilitation, the plan also needs review.

Pain management in hospital should connect with early mobility, delirium prevention, falls prevention, bowel care, sleep, nutrition and rehabilitation rather than becoming an isolated medication task.

This becomes especially important during transfer to rehabilitation or transitional care. A person may arrive with several new analgesics but no clear explanation of which pain each medicine is intended to treat, which medicines are temporary, what adverse effects need monitoring or when treatment should be reviewed. Conversely, medication may be reduced at transfer even though the remaining pain prevents meaningful rehabilitation.

A functional handover should communicate more than the prescription. It should include the likely cause or mechanism of pain, its current pattern, which movements or activities trigger it, the person's functional goals, which interventions have helped, important adverse effects and the review or tapering plan where relevant.

A medicine started for a few postoperative days should not automatically become a long-term treatment because no one revisited the indication. Equally, abrupt changes to established pain treatment can create new problems.

Pain therefore needs continuity across the medication plan, the rehabilitation plan and the person's wider care plan.

Home and long-term care need pain management that works in real life

Pain management at home is different from pain management on a hospital ward. There may be no clinician available to reassess someone several times a day. The older person may have difficulty reading labels, remembering doses or opening packaging. Several relatives may be involved, each with a different understanding of the regimen. Old prescriptions may remain in a drawer and reappear when pain returns. Different products may contain the same active ingredient without the family realizing it.

A safe home plan needs to be understandable and feasible. The older person and caregiver should know what each medicine is intended to do, whether it is taken regularly or only when needed, which adverse effects should prompt review and which products should not be duplicated. They also need to understand the non-drug parts of the plan, whether those involve movement, positioning, rehabilitation, assistive products or other individualized strategies.

For someone who is highly dependent, caregiver capability becomes part of pain quality. A theoretically ideal plan that depends on an exhausted spouse performing transfers they cannot safely manage is not a sustainable plan.

Long-term care creates another challenge: pain can gradually become invisible because it develops alongside frailty, cognitive impairment and multiple chronic conditions. A resident begins refusing to stand. Another becomes distressed during bathing. Someone who previously joined communal meals starts staying in their room. These changes may be attributed to “dementia,” “aging” or reduced motivation when pain is one possible contributor.

Good long-term care therefore needs a routine process for recognizing, assessing, managing and reassessing pain. Staff need to know when self-report is still possible, when observational assessment should supplement it and when new behavioral or functional changes require clinical review rather than automatic escalation of sedating medication.

Not every pain problem requires a pain specialist. Some can be managed through primary or facility-based care; others may require dentistry, rehabilitation, orthopedics, neurology, rheumatology, palliative care or specialist pain services. The quality issue is whether a workable escalation pathway exists and whether the relevant information follows the person when care moves between settings.

Palliative pain management has different priorities

Pain in palliative and end-of-life care deserves a distinct approach. Safe care still matters, but the balance among comfort, alertness, longevity and treatment burden may change according to the person's condition, prognosis and goals.

Some medicines that would be undesirable in routine chronic pain management may have a legitimate role when the overriding objective is relief of significant suffering. This is one reason medication-safety tools should not be applied mechanically. The AGS Beers Criteria themselves exclude hospice and end-of-life care from their intended scope.

Palliative pain management also requires careful communication with families. Some relatives may fear that stronger analgesia means “giving up,” while others may expect every sign of discomfort to disappear completely. Shared decisions should explain what treatment is intended to achieve, what benefits are realistic and what adverse effects may occur, while keeping the older person's own preferences central as far as possible.

A palliative approach does not mean abandoning assessment. It means aligning assessment and treatment with the person's goals and stage of illness.

Quality measurement should focus on what matters, and the workforce needs to know how to act

Organizations often measure pain by asking whether a pain score was recorded. That is useful, but it tells us little about whether the person ultimately received better care.

A stronger quality approach asks whether pain was recognized when clinically relevant, whether someone unable to self-report received an appropriate observational assessment, whether significant pain resulted in a documented management plan and whether the response to that plan was reassessed.

Outcomes should also extend beyond pain intensity. Can the person now walk further, sleep better or participate in rehabilitation? Can they perform more everyday activities independently? Has distress decreased? Have treatment-related problems such as falls, delirium, constipation or excessive sedation occurred?

The Vietnamese National Geriatric Hospital study is particularly relevant because it shows how closely greater pain severity and everyday functional dependency can be linked. A service that reduces average pain scores while increasing sedation and dependency has not necessarily improved older-person care.

Pain management is also a workforce competency, not the responsibility of pain specialists alone. Doctors, nurses, pharmacists, rehabilitation professionals, dentists, palliative-care teams, care workers and family caregivers all see different parts of the pain picture. A physiotherapist may notice pain only during weight-bearing. A nurse may recognize increasing nighttime discomfort. A pharmacist may identify duplicate analgesics or a high-risk drug combination. A family caregiver may notice a new grimace during dressing. A dentist may discover that what appears to be poor appetite is actually oral pain.

Good systems make those observations connect. Staff need practical competence in recognizing pain, using suitable assessment approaches, identifying red flags, understanding major medication risks, supporting appropriate non-pharmacological strategies and knowing when escalation is necessary.

Assessment without action is documentation. Treatment without reassessment is incomplete care.

A practical pain-quality framework for Viet Nam

Viet Nam does not need to wait for a stand-alone national geriatric pain guideline before strengthening pain care within older-person services. Current Ministry of Health guidance, contemporary pain science, geriatric medication-safety principles and emerging Vietnamese evidence already provide useful building blocks.

Recognition should ensure that pain is actively considered rather than normalized as part of aging. Assessment should use self-report whenever possible and consider location, pattern, likely mechanism, emotional effects and functional impact, with structured behavioral observation when verbal communication is limited. Diagnosis and escalation should identify treatable causes and red flags rather than simply suppress symptoms.

Management should combine appropriate non-pharmacological and pharmacological strategies according to the type of pain, clinical condition and person's goals. Medication safety should consider multimorbidity, renal and hepatic function, drug interactions, cognition, falls and overall treatment burden. Function and rehabilitation should remain central so that pain relief helps people move, participate and remain as independent as possible rather than becoming an endpoint in itself.

Caregiver support should make the home plan understandable and realistically deliverable. Transition management should communicate the pain problem, goals and review plan rather than merely copying the medication list. Reassessment should determine whether treatment has improved comfort and meaningful function without creating unacceptable harm. Measurement and learning should help organizations understand whether pain is being recognized, acted upon and managed safely across the care continuum.

These elements only work when they operate as a system. A pain score does not compensate for the absence of a plan. A prescription does not compensate for failure to understand what matters to the person. Exercise may be impossible if pain is poorly controlled. Stronger analgesia may create more harm than benefit if sedation, falls or delirium are ignored. And a successful hospital plan can fail within days if it does not survive the transition home.

From pain relief to preserving function and dignity

For an older person, good pain management is not simply about making a number smaller. It may mean being able to stand without fear, walk to the bathroom, sleep through the night, continue rehabilitation, hold a grandchild, sit comfortably through a meal or remain alert enough to enjoy a conversation.

For families, it means understanding how to help without being left to improvise complex treatment alone. For hospitals, it means balancing adequate analgesia with mobility, cognition and safety. For rehabilitation services, it means reducing pain as a barrier to recovery. For home and community care, it means creating a plan that can actually be delivered. For long-term care, it means recognizing pain even when the person can no longer describe it clearly.

As Viet Nam strengthens age-friendly, integrated and long-term care, the question should therefore not simply be “What is this person's pain score?”

A more meaningful question is:

“Do we understand this person's pain well enough to relieve avoidable suffering, protect them from treatment-related harm and help them continue doing what matters to them across every care setting?”

That is the difference between treating pain as a symptom and managing pain as part of high-quality older-person care.

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