Accurate pain assessments begin when clinicians believe patients and take their pain complaints seriously. Because no objective biological markers for the presence of pain exist, the current best indicator of the pain experience is the patient’s own report, which must include an assessment of pain intensity and an evaluation of the pain’s effect on daily function. Pain has been described as the “fifth vital sign” and as such, the American Geriatrics Society recommends that all elder patients should be assessed for evidence of persistent pain upon initial presentation or admission to any healthcare service. Additional painful medical conditions more common in older patients include herpes zoster, temporal arteritis, polymyalgia rheumatica, and atherosclerotic peripheral vascular disease.3 Cancer is also a cause of severe pain in older patients, especially near the end of life. Osteoarthritis may affect 80% of individuals over the age of 65 and most of those affected experience significant pain.
Musculoskeletal disorders probably account for the most common causes of pain in elders. There are multiple causes of pain that can affect older patients, and pain is generally best treated when the specific underlying cause is identified. Persistent pain is an issue for up to 40% to 60% of community-dwelling elders and 40% to 80% of those who are institutionalized.4 In the elder population, inadequately treated pain frequently leads to other problems, including depression, anxiety, sleep disorders, decreased quality of life, and reduced independence.5,6 In the United States, it is estimated that up to 80% of older individuals residing in long-term care facilities experience pain that impairs functionality and negatively affects their activities of daily living, mood, and quality of life.7Įffective pain management in older patients requires physicians to be skillful in the appropriate assessment of pain, possess knowledge and skill related to the appropriate use of pharmacologic and nonpharmacologic interventions, and be aware of the aspects of pain management unique to this population.8 Concerns about drug toxicities, drug interactions, and patients’ fear of treatment are all factors warranting consideration in managing patients’ pain, but these issues do not have to become barriers to effective treatment. Unfortunately for many older patients, the term “chronic pain” has become a label associated with negative images and stereotypes often linked to long-standing psychiatric problems, futility in treatment, malingering, or drug-seeking behaviors.3 For this reason, the term “persistent pain” is preferred in the medical literature and will be used throughout this article as it may foster a more positive attitude toward pain identification and treatment by both patients and prescribers. Chronic pain is described as pain that lasts longer than three months or, perhaps more appropriately, as pain that persists beyond the expected time frame for healing.1,2 Pain, defined as an unpleasant sensory and emotional experience, is common among older patients yet often goes unrecognized and is frequently undertreated. Winter 2011 Persistent Pain - Three Keys to Effective Pain Management in Elders
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