By Liz Seegert
Many older adults live with chronic pain. It may be related to arthritis, complications from diabetes, falls, surgery, or other causes, but aging and pain go hand-in-hand for an estimated 58 percent to 70 percent of community-dwelling adults over age 65 and up to 80 percent of nursing home residents. Although physiologic changes are inevitable as we get older, persistent pain is not part of a normal aging process.
An International Association for the Study of Pain fact sheet said that nearly half (45 percent) of older adults admitted to hospitals report pain – 19 percent have moderate or severe pain and 12.9 percent are not satisfied with current pain management methods.
Chronic pain in older adults is often underassessed and undertreated, according to numerous studies. If you plan to report on pain-related issues, here are some things to keep in mind.
- Chronic pain can lead to increased hospitalizations, use of medical services and prescription drugs.
- A 2011 Institute of Medicine Consensus Report: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, calls pain a “significant” public health problem, costing society at least $560-635 billion annually in incremental health costs and lost productivity. That’s more than diabetes, coronary heart disease, stroke and cancer combined.
- Common chronic pain among older adults includes headache, low back pain, cancer pain, arthritis pain, neurogenic pain and muscle pain.
- Chronic pain hampers an older person’s ability to move around easily, perform activities of daily living and quality of life, according to the Health In Aging Foundation.
- Sleep problems, mood changes, anxiety and depression may result.
- There is also greater risk of falls, poor concentration and relationship difficulties.
Assessment and management of chronic pain is challenging for caregivers and clinicians. Age-related cognitive and behavioral factors affect reporting and treatment of pain. Additionally, age-related physical changes affect pharmacologic management; pharmacokinetics in seniors differ from younger adults, which can increase risk of adverse drug reactions and side effects.
Chronic pain often goes unreported by seniors; if they do report it, they tend to minimize the severity. An American Geriatrics Society panel on persistent pain in older adults called on health providers to do a better job of pain assessment: “On initial presentation or admission of any older person to any healthcare service, a healthcare professional should assess the patient for evidence of persistent pain. Any persistent pain that has an impact on physical function, psychosocial function, or other aspects of quality of life should be recognized as a significant problem.”
Overcoming chronic pain can take several different routes, separately or in combination. Mindfulness meditation and other mind-body interventions such as biofeedback and yoga, have been effective in some community-dwellilng older adults, but more evidence is needed to prove these interventions work consistently. Other studies have looked into the effects of physical activity, and pain self-management training.
Prescription medication such as opioids and over-the-counter topical treatments like NSAIDs, are commonly prescribed for arthritis, low back, neuropathic and other types of pain. However, a 2012 Milwaukee Journal Sentinel article pointed to a dramatic 32 percent jump in the number of prescriptions written for painkillers after the aforementioned 2009 AGS panel guidelines were published.
The Journal Sentinel investigation found that several doctors on the panel had received money from drug companies, which biased their opinions, resulting in statements that misled the public about safety, efficacy, and addition of pain medication.
ProPublica recently unveiled its “Prescriber Checkup” database – an online analysis tool for journalists and others to compare top Medicare Part D prescribers for 2010 by state, by drug, and by physician. Several states, including Kentucky, have made state prescribing databases available online in efforts to improve transparency and monitor potential abuse by both physicians and patients.
Story ideas:
- Who are the top prescribers for pain medication in your city or state?
- How are local nursing homes managing residents’ chronic pain issues – particularly those with dementia who may not be capable of articulating their pain levels?
- What “sunshine” law(s) are in effect in your state to monitor prescribing habits of doctors or pain specialists?
- Are there any local programs available (e.g., yoga, meditation, water therapy) geared toward pain management in the senior population?
- What about volunteer organizations that offer pain management services for elders such as massage therapy or tai chi?
- Visit the local senior center and speak with some of the attendees – who is in pain, how does it affect their quality of life, how are they coping (or not).
- Contact the local geriatrics society to discuss the benefits and drawbacks of various therapies, as well as issues such as medication or care plan compliance, availability of services (from senior-friendly community programs to help with activities of daily living)
- Talk to nurses, nurse-practitioners, physician assistants — who are frequently the first to assess pain levels in older patients. What are they seeing/hearing? What are greatest challenges?
Additional sources:
- CDC Vital Signs: Overdoses of Prescription Opioid Pain Relievers 1999-2008
- National Health Interview Survey Data (2012)
- Gallup (2011 data) Chronic Pain Survey
- Oregon Pain Management Commission (2011 data)
- Pain by the Numbers
- Tufts Univ. Pain Education, Research and Policy Program
- Administration on Aging Chronic Disease Self Management Education
- American Assisted Living Nurses Association
- American Chronic Pain Association
- ACPA 2013 Resource Guide to Chronic Pain Medication and Treatment
- Managing Chronic Pain in the Elderly (Clinical Interventions in Aging, Jan. 2013)
- Complementary and Alternative Interventions for Managing Chronic Pain in Older Adults (Clinical Geriatrics, 2013)
