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Guide to Managing Chronic Pain in the Elderly

Chronic pain is one of the most common conditions suffered by older adults. A National Institutes of Health (NIH) funded study indicates that nearly 53% of seniors, over the age of 65 experience persistent pain. Untreated or undertreated chronic pain can lead to a variety of negative consequences – avoidance of activity, reduced mobility, increased risk of falls, depression, anxiety, sleep disorders, and isolation.

As a caregiver, understanding of the unique characteristics of chronic pain in older adults as well as how to effectively assess and manage that pain can significantly enhance your loved one’s quality of life.

What is chronic pain?

One of the biggest challenges of managing chronic pain is simply defining it.

Chronic pain is loosely defined as any pain that lasts beyond an expected healing period and may or may not be associated with an identifiable cause or damage.

As we age, it is increasingly common to suffer nerve pain associated with diabetes, shingles, cancer, or surgery. Chronic pain can also be the result of a variety of chronic diseases, like congestive heart failure, renal disease, and pulmonary obstructions. And finally, persistent pain could also be the result of joint and skeletal surgeries, arthritis, deteriorations, compressions, and fractures.

Why is pain so underreported in the elderly?

Probably one of the most shocking things about chronic pain in older adults is the underreporting and treatment. There are many reasons older adults might ignore chronic pain:

  • Diseases often have an atypical presentation in older adults because of a variety of physiological changes due to aging
  • Many older adults incorrectly assume that chronic pain is a natural part of aging
  • Some seniors fear additional examinations or medications
  • Those who have experienced pain associated with a disease may fear the prognosis of further disease progression

Caregivers play a significant role in finding chronic pain relief.

Caregivers can be the most useful source of information and advocacy for a multidisciplinary approach to pain assessment, diagnosis, and management. By engaging healthcare providers – physical therapists, physicians, psychologist, psychiatrist, and assisted living or in-home care providers – on behalf of your loved one, you can assure that their pain is reported and treated at an appropriate level to maximize the quality of life.

How can caregivers address chronic pain in the elderly?

With a better understanding of chronic pain in older adults, how do caregivers go about treating these bothersome pains?

Your best opportunity for successful chronic pain relief is working collaboratively with your loved one’s healthcare providers.There are some general steps and knowledge that can guide you as you work with these professionals.

Assessment of Pain

The first logical step is to accurately evaluate the pain and level of distress. But, for all of the reasons that older adults often don’t report or under-report pain, it can be equally challenging to evaluate.

Some of the most common methods for evaluating pain are assessment scales. These assessment tools can use simple descriptive scales, such as “describe your pain on a scale from none to agonizing”; numeric scales, like “describe your pain on a scale of 1 to 10, with 0 being no pain and 10 being unbearable pain; or visual analog scales, such as “point to your level of pain on this line from no pain to unbearable pain.”

Remember that some seniors may have trouble communicating about their pain because of cognitive or emotional impairment. This makes it important for caregivers to be active observers of their loved ones, especially when a cognitive decline or another condition might get in the way of them accurating describing their pain.

Some of the best evidence for heightened or chronic pain might be increased agitation, changes in functional status or body posture and gait, and social isolation. If you begin to notice any of these symptoms, it might be a good time to do a pain assessment with your loved one.

Pharmacologic Management of Pain

Pharmacologic (the use of drugs/medication) intervention is often used in the  treatment and management of chronic pain.

When considering the use of pharmaceutical medications, it’s essential that you consult and collaborate with your loved one’s physician – the risk of adverse drug reactions in slightly higher in the elderly.

Doctors must be mindful of the age-associated differences in the chemistry and dynamics of pharmaceuticals as well as potential drug interactions with other drugs and diseases. One of the other challenges with pharmacologic pain management is the understanding that geriatric patients often require different dosages and concentrations of medications, but focused clinical trials are few. Therefore, carefully monitoring side effects and being as targeted as possible with treatment is essential. There is also a risk of addiction when using opioid-based drugs.

Nonpharmacologic Management of Pain

Many older adults may benefit for nonpharmacological approaches. These methods may help even if your loved one is taking medication for pain.

Some of the things to consider when pursuing nonpharmacologic treatment options:

  1. Educate yourself (as a caregiver) and your loved one on pain management, goal-based therapy, pain assessment, and the appropriate use of complementary and alternative treatments
  2. Explore osteopathic manipulative treatments for a holistic approach to pain reduction and increased function
  3. Include cognitive-behavioral therapy to help educate and develop chronic pain coping and prevention skills
  4. Use exercise to help target current sources of chronic pain and enhance function, capacity, and avoid deconditioning as a means to prevent future pain. (Make sure you consult with your doctor first.)
  5. Consider the use of other complementary therapies, such as psychiatry, physical therapy, massage, acupuncture, and spiritual counseling

Chronic Pain Management is Essential

Pain isn’t necessarily an inevitable part of aging and proactively preventing and addressing familiar sources of chronic pain can help you or your loved one live a more active and happier life.

The better educated you are about chronic pain management and therapy options, the better equipped you are to help yourself, or a loved one reduce or eliminate pain that shouldn’t be slowing you down.

Chronic Pain Management Workshops

The Area Agency on Aging 1-B offers a class to help you or your loved one learn to manage and cope with chronic pain. Our Chronic Pain Management classes are built on the Personal Action Toward Health (PATH) model, an evidence-based approach proven to help people learn to cope with chronic conditions. Our workshops meet once a week for six weeks and are held in community venues throughout our six-county southeast Michigan region. Classes are held in a small-group setting and are led by instructors who have often experienced chronic pain themselves, so they have a first-hand understanding of the challenges. This small group setting can also help you build a support community and learn from  other people’s experiences.

With PATH Chronic Pain Management classes, you’ll learn how you can:

  • Make an action plan
  • Solve problems
  • Deal with difficult emotions
  • Relax
  • Manage pain and fatigue
  • Make informed treatment decisions
  • Work better with your healthcare professional

To find a class near you, call (833) 262-2200.