Older Adults – and Their Doctors – Should Not Ignore Pain Signals
By Darien Behravan, D.O.
Because persistent pain is a common experience among older adults, it is often dismissed as a normal part of aging. As the American Geriatrics Society (AGS) points out, however, pain is neither normal nor healthy, and complaints about pain should never be minimized or passively accepted.
Unfortunately for elders, both physicians and patients alike may overlook pain signals and neglect treatment. As many as one half of independent older adults in the U.S. suffer from persistent pain, yet 47 to 80 percent of them do not receive treatment for it. Further, 75 percent of elders in care facilities live with this problem, but up to 27 percent of them receive no treatment for pain, according to reports published by the National Pain Foundation.
The problem is two-fold: older patients may be unable or unwilling to speak up about their pain, and doctors may not ask about it, or they may not ask the right questions often enough.
To deal with the problem, patients (or their caregivers) can keep a “pain diary,” a journal that documents the location and frequency of a person’s physical pain as well as any activities that make it better or worse. For their part, medical professionals can implement guidelines developed by the AGS, which provide pain screening questions as well as up-to-date information on medication protocols.
In addition, medical professionals can strive to recognize the differences between managing pain in the elderly, whose health may slowly and gradually deteriorate, and treating cancer patients, who may be healthy until shortly before the end of life when they rapidly go downhill.
Rather than relying exclusively on short-acting pain drugs, those treating older adults can adopt a comprehensive, multi-disciplinary pain management approach to include physical, psychological and behavioral therapies; injectional therapy; or implantable pain devices.
Fitness programs, water aerobics, nutritional guidance, alternative therapies (such as acupuncture), and spiritual support and interventional injection therapies might all be woven into this integrated pain management approach.
Two factors, however, can hinder the best efforts to treat pain in older adults: dementia and depression. Patients with dementia may not be able to describe their pain in words. The inability to communicate verbally, however, does not negate the possibility that the pain exists.
For those suffering from depression, a condition often under-diagnosed in the elderly, it can be critically important to reduce pain. Persistent pain can make it hard for patients to get adequate sleep and can leave them feeling irritable and sad. As a result, pain and depression may chase each other in a vicious cycle making both harder to treat.
On the other hand, when persistent pain is recognized and treated properly, it can vastly improve the function and quality of life for older patients. Even though pain may not be entirely eliminated, it can be reduced.
# # #
Dr. Behravan is an anesthesiologist with fellowship training in pain management. He is also chief of division of pain at Eden Medical Center.