Pain in older persons

Abstract

Chronic pain is more prevalent in older persons than in young adults. In this review the physiological, pathological, and psychological reasons for altered pain sensibility in older persons are explored and strategies for the management of pain in older persons described. The evidence suggests that altered physiology of peripheral and central pain mechanisms combine with psychological attitudes, such as stoicism and reluctance to confirm the presence of pain, to raise pain threshold. However, once pain is experienced, older persons describe the same severity, quality, and psychological disturbance as younger persons. There is some evidence to suggest that the complaint of pain in the presence of pathology is reported less often in older persons. On the other hand, the presence of persistent or recurrent clinical pain may have a greater impact on the psychological, social, and physical function of older adults. It is also clear, however, that further empirical studies are required in order to delineate the age-related differences and similarities in the chronic pain experience. Management of chronic pain in the elderly requires meticulous diagnosis of the causal pain mechanisms as well as a holistic approach which gives due regard to psychological and social consequences of pain.

Race, age, and gender influences among clusters of african american and white patients with chronic pain

“…19,20,65,68,69 An emerging literature suggests that demographic factors (ie, race, ethnicity, age, and gender) are important and necessary considerations when evaluating health and the pain experience. 4,13,16,17,[23][24][25]49,50,59,67 For instance, racial and ethnic minorities, older people, and women might be more vulnerable to the health effects of chronic pain. 1,3,[8][9][10][11]42,75 In an increasingly diverse and aging American society, there is heightened concern about the high prevalence of chronic pain as well as its differential impact on health in vulnerable populations.…”

Changes in Pain Perception and Descending Inhibitory Controls Start at Middle Age in Healthy Adults

“…As elderly adults are generally thought to expect higher levels of pain 11 we also tested the possibility that expectations of pain explain part of the age-related change in DNIC strength. Our results failed to support this hypothesis as expectations of analgesia did not change as a function of age but the strength of the DNIC response did.…”

“…This hypothesis is certainly plausible given evidence that older adults usually expect higher levels of pain than younger adults. 11 To our knowledge, no study has ever controlled for the effects of expectation when evaluating the relationship between DNIC and age.…”

Individual differences in pain responses

“…For example, older age has been associated with the onset of and persistence of clinical pain [28]. Older adults also appear to expect more pain, report a greater number of body sites affected by pain, and show higher levels of pain-related interference with daily activities [29,30]. In addition to these clinical and epidemiologic findings, there is evidence that pain perception changes with age.…”