Pain Management in Older Adults: Prevention and Treatment

Abstract

The release of guidelines in 1998 by the American Geriatrics Society on "The Management of Chronic Pain in Older Persons" was a breakthrough in helping to manage pain in this population. Already advances have fostered a need to update recommendations. This article focuses on the treatment strategies available for seniors that are likely to help to fulfill the obligation to relieve pain and suffering in patients. A review was done of the literature using Medline and other search techniques. New pain scales have been developed with seniors in mind and greater testing of older scales in elderly populations have helped to identify measures of pain more suited to frail seniors. Advances in cyclooxygenase inhibition selectivity, alternative medicine, and progress in the identification of nonopioid pain receptors and the development of products to target them are just a few of changes that have altered the way clinicians think about treating pain. The use of hospice in end-of-life palliative care is a valuable resource for clinicians managing pain at that phase in care as well. Tools are available to prevent and treat pain successfully in seniors. Educating clinicians about available assessment tools, techniques and interventions may be the biggest challenge to comforting the older adult in pain.

Patients’ experiences of living with peripheral arterial disease awaiting intervention: a qualitative study

“…Similar findings in older people's decision making about the management of musculoskeletal pain showed that they focused on the negative dimensions of medication and preferred to use a combination of strategies to relieve the pain (Ross et al, 2001). The drug distribution is usually different in older patients because of blood flow to organs, protein binding and body composition that occurs with ageing (Gloth, 2001). This could explain the experiences of side effects described in this study, since the majority of the respondents were over 75 years old.…”

Recommended management of cancer pain in the older patient

“…5 Transcutaneous electrical nerve stimulation (TENS), acupuncture, relaxation techniques and massage may all be of benefit. Appropriate Prescribing in older people review and inter vention by both physiotherapy and occupational therapy may improve pain through rehabilitation and functional aids.…”

Management of Chronic Musculoskeletal Pain in the Elderly: Dilemmas and Remedies

“…Brown et al report higher percentage and state that more than 90% of the elderly living in the community experienced pain within the past month [6]. Given the prevalence of chronic pain, its impact on health, and its costs, which approach $100 billion annually, chronic pain represents a major public health issue [20].While the existence of acute pain remains approximately the same across the adult life span, there is an age-related increase in the prevalence of chronic pain at least until the seventh decade of life [13,15]. Approximately 57% of older adults report experiencing pain for 1 or more years compared with less than 45% of younger people.…”

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Pain in Perspective 94percent of community dwelling adults aged 60 years or above have been found to experience pain and this number increases to 45-80% in the nursing home population with analgesics being used in 40% to 50% of residents [1,[13][14][15][16][17][18][19]. Brown et al report higher percentage and state that more than 90% of the elderly living in the community experienced pain within the past month [6].

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“…Arthritis alone affects well over 20 million Americans with an increase to 40 million expected by 2020. Twenty-nine percent of Medicare patients in nursing homes with a fracture in the prior 6 months suffer with daily pain [13]. Also surgical procedures are more frequently performed on older people.…”