Chronic physical pain from arthritis and lower back injury is common among many older adults, and frequently is inadequately addressed. For older adults, chronic pain can lead to depression, fatigue, decreased socialization, sleep disturbance, impaired ability to move and walk. It can also lead to emotional isolation from being disabled or functionally impaired. Women are more likely to report musculoskeletal pain and to have pain in several parts of their body than men are.
Some older adults deal with pain by self medicating with alcohol or misuse of multiple medications. No wonder, alcohol has traditionally been used as a basic and effective analgesic since ancient times. In its various forms, it has been considered a superior anesthetic weapon.
There are currently many misconceptions about the likelihood of people with chronic pain developing addictions from their use of opioids for pain management, and Canadian guidelines are not always clear for physicians when prescribing these. This can lead to lower than optimal prescriptions for pain to achieve best therapeutic value. The misconceptions and stereotypes about addictions become particularly acute when physicians and other health care providers deal with older adults, including those with alcohol use problems.
In some cases, older adults are erroneously believed to have less feeling of pain as they age, or are expected to simply accept it as part of growing older. Both are incorrect. It is essential for older adults to have their pain properly addressed so that they can maintain their abilities and independence as long as possible and maintain a reasonable quality of life.
The National Advisory Council on Aging's September 2002 newsletter, titled "Stop the Pain!" provides a very readable newsletter on the subject of seniors and pain. Available on the Internet (See:
www.naca-ccnta.ca/expression/15-3/exp15-3_toc_e.htm) or you can order a copy from them.
Test Your Pain Knowledge
If you are an older adult or if you are doing any work in your agency or with seniors you might be interested in this little quiz that tests peopleís knowledge about aging and pain. It highlights some of the common misconceptions people may have about pain in later life.
Try it yourself.
True or False?
1) Pain is a natural outcome of growing old. (Correct answer: False)
2) Age dulls a personís sensitivity to pain. (Correct answer: False)
3) Pain Medications should only be taken if pain is severe. (Correct answer: False)
4) If an older adult doesnít report any pain, he or she likely does not have pain.
(Correct answer: False)
5) We should assume an older personís pain has lessened if they appear to be busy, asleep or otherwise distracted. (Correct answer: True)
6) Narcotics should be strongly considered when treating severe pain in older adults.
(Correct answer: True)
7) People often receive too much pain medication. (Correct answer: False)
8) People who have Alzheimerís disease generally do not feel pain. (Correct answer: False)
9) Over time, people taking pain medication generally become addicted. (Correct answer: False)
10) Older people tend to report more pain as they age. ((Correct answer: False)
Source: Gomez, S. Osborn, C. Watkins, T. & Hegstrom. (March 1, 2002). Caregivers team up to manage pain. Provider, Vol 28 (4) 51-58.
Research on Older Adults, Alcohol and Pain
Many older adults suffer from pain and a significant proportion have unhealthy alcohol use. To examine the relationship between pain and alcohol problems among older adults, researchers studied 401 community-dwelling older adults at the beginning of the study and 3 years later. The participants were aged 62-72 years.
At the beginning of the study, more of the problem drinkers* than non-problem drinkers reported having moderate to very severe pain (about 43 percent versus 30 percent). More problem drinkers were experiencing functional impairment from pain (about 33 percent versus 18 percent of the non problem drinkers).
A greater proportion of problem drinkers used alcohol to manage their pain (about 38 percent versus 14 percent). These proportions were higher among the older adults with moderate to very severe pain (about 58 percent versus 21 percent).
The level use of alcohol at the beginning of the study to manage pain predicted
Brennan PL, Schutte KK, Moos RH. Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers. Addiction, 2005; 100(6): 777-786.
It has been suggested that clinicians need to:
References on Older Adults and Chronic Pain
Management of persistent pain in older persons. Journal of the
American Geriatrics Society. 50 (6, Suppl.), S205-S224
All, A.C. & Huycke, L. J. (Sep-Oct 1999). Pain, cancer, and older adults. Geriatric Nursing. 20 (5), 241-248.
Bishop, K. L, Ferraro, F.R., & Borowiak, D. M.(2001). Pain management in older adults: role of fear and avoidance. Clinical-Gerontologist. Vol. 23 (1-2), 33-42
Gallagher, R.M., Verma, S., & Mossey, J. (Sept. 2000). Chronic pain: sources of late-life pain and risk factors for disability. Geriatrics. 55 (9), 40-44.
Freedman, G.M. (May 2002). Clinical management of common causes of geriatric pain. Geriatrics. 57 (5), 36-42
Hubbard, J. R.& Workman, E.A. (2001). Chronic pain and substance-related disorders. In: J.R. Hubbard and P.R. Martin, Eds., Substance Abuse in the Mentally and Physically Disabled, New York, NY: Marcel Dekker Inc. (pp. 241-263)
Helpful Summary of Chronic Pain Resources
Note: There is interesting research being done at the Centre for Aging and Health at the University of Regina on psychosocial approaches to pain management in older adults.
2004 Events for Health Care Providers
Pain Symposium, Hamilton, Ontario, September 23-24, 2004
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Seeking Solutions, Page last updated: Friday January 20, 2006