The article addresses the challenges of pain management in elderly surgical patients due to the increasing aging population worldwide. The elderly population faces a higher prevalence of surgical pathologies and chronic pain conditions, making pain control a significant concern for anesthesiologists. The neurophysiology of pain perception changes with age, affecting both the peripheral and central nervous systems. Neurochemical alterations and reduced neurotransmitter levels impact nociception and pain modulation, potentially leading to chronic pain issues in elderly patients. The physiological changes that come with aging also affect the pharmacokinetics and pharmacodynamics of drugs used for pain management. These changes require careful consideration when selecting appropriate analgesics. This article suggests various pharmacological options for pain management in elderly patients. However, it emphasizes the importance of a multimodal approach to pain management, considering non-pharmacological interventions as well. The authors conclude that treating pain in elderly patients requires a comprehensive understanding of the physiological changes related to aging and individual comorbidities. More research is needed to improve pain management strategies for this growing population.