Guide to Managing Elderly Chronic Pain

An unpleasant and complex sensory, emotional experience comes under the category of pain. Pain is never expected, and when it lasts beyond the time of healing or continues for a period of three months or longer, it comes under the category of chronic pain.

Unlike wrinkled skin or graying hair, chronic pain is not a part of the normal aging process. For older adults primarily who live independently, chronic pain may have devastating and widespread effects, imposing steep economic and social costs, threatening the quality of life, and personal strain.

Even after extreme pain, many older adults do not discuss their problem and its impact on their healthcare providers because they fear invasive tests, loss of independence, hospitalization, or need to take additional medicines. It may cause underdiagnosis resulting in inadequate treatment, further diminishing quality of life.

Chronic pain is continuously a point of concern as the elderly population grows. According to a survey, in 2016, the number of Americans older than 65 years was about 36 million, 12.4% of the population. By 2030, this group of people may number 70 million (about 20% of the total population).

Causes of Chronic Pain

Advanced age increases the risk of specific health problems that can cause chronic pain. Conditions that can cause chronic pain in older adults may include musculoskeletal disorders such as osteoporosis and arthritis, peripheral vascular disorders, and neuropathic pain (postherpetic neuralgia).

How pain disrupts the quality of life?

Chronic pain is linked to depression, sleep disturbances, poor physical functioning, and reduced social activity. Pain-linked problems can make older adults more dependent on others for ADLs (activities of daily living) and may result in social isolation and a rise in healthcare costs. Pain is commonly seen as a threat that influences older adults’ coping processes.

Effects of pain on sleep

Chronic pain can disrupt your sleep in several ways. Altogether, falling asleep is problematic for various older people who have endured chronic pain stress in the day. Sleep quality may suffer because of frequent awakenings, as continuously changing sides on the bed may cause pain.

Sleep deprivation and alteration in sleep quality can lessen the pain threshold. Thus, a vicious sleep-deprived cycle occurs with lowered pain threshold, decreased sleep quality, and reduced ability to cope with chronic pain.

Depression and Distress

Many older people with chronic pain experience extreme distress or even depression which can obstruct their ability to handle or cope with pain. Additionally, the pain may worsen your cognitive dysfunction and malnutrition.

Along with financial hardship and other factors, chronic pain contributed to depression and distress among community-dwelling older adults. The chronic pain caused by arthritis interferes with daily activities and makes it harder for such people to carry out daily activities (ADLs), and it can cause distress.

Chronic pain can be directly linked to depression, and people might adapt to chronic pain and may not appear to be distressed daily; pain may create long-term effects manifesting depression.

Assessment

Assessment of chronic pain in older adults can be challenging due to the population tends to underreport pain. Also, unlike patients with acute pain, those with chronic pain usually do not manifest autonomic pain responses, such as a sudden increase in heart rate and respiration.

Using a pain scale is beneficial while assessing an older adult for pain. A doctor may encourage their patient to keep a pain diary to help identify events that precipitate or increase pain. A pain diary can also offer clues about the occurrence of breakthrough pain. If the findings from the assessment suggest the patient has chronic pain, try finding out whether and to what level the pain is affecting the quality of life of an individual.

Plan of Care

Medical healthcare providers must develop a proper plan to address the patient’s chronic pain. The program should check the patient’s comfort-function goal and identify the pain management needed to reach the required functional ability.

Establishing a realistic and practical comfort-function goal offers direct patient input into their pain management and its implementation. It also holds both the medical healthcare team and the patient accountable for providing adequate pain relief.

Some older adults may need more help in establishing realistic goals. Firstly, inquire about the pain-related functional limitations that the person finds distressing.

Pharmacologic Pain Management

There are various pharmacologic pain management options. However, physiologic changes in the continuously aging body and coexisting health problems can challenge pharmacologic measures in the elderly.

Such physiological changes alter drugs’ pharmacodynamics and pharmacokinetics. For some reason, some medications are not very appropriate for pain management in older adults. Here is a list of potentially inappropriate medications for pain management in older adults, including:

  • Classes of drugs or medicines generally should be avoided in people 65 years or older because they may be ineffective or pose an unnecessarily high risk. I prefer taking a safer alternative available for older adults.
  • Medications that one should not prescribe to older adults who have certain medical conditions.

For many patients, the plan for pain management may need to include pharmacologic methods and nonpharmacologic methods.

Promoting Compliance with Drug Therapy

Compliance with any therapy can pose a challenge for both the patient and medical healthcare provider. Many elderly patients mistakenly think that they should take analgesics only when the pain becomes hard to handle; some patients fear becoming addicted to them. The doctor should emphasize the importance of using pain medication to stay in a better condition, rather than waiting for the pain to become unbearable.

Some older people may avoid pain treatment because of the risk of constipation and other adverse effects. Suppose fear of constipation obstructs the patient from taking the required medication. In that case, the medical healthcare provider should educate them about beneficial dietary changes, such as eating more fiber-rich food and drinking more fluids.

Nonpharmacologic Pain Management

In most cases, various older adults are open more to nonpharmacologic approaches for pain management. As per the requirements and adaptability status, teach patients about relaxation, exercise, guided imagery, acupuncture, yoga, spiritual interventions, and music therapy. Some other popular nonpharmacologic pain management options include:

  • biofeedback
  • humor
  • repositioning
  • distraction such as reading a book, watching television, or talking on the phone

In some situations, application or massage of something heat and cold may be appropriate. But take caution in older adults who have neuropathic pain or ischemic pain due to peripheral arterial disease. In those conditions, using heat and cold may lead to altered sensation at the extreme level and damage tissues. One must encourage their patients with joint pain or arthritis to stay as active as possible and participate in non-weight-bearing activities, such as swimming, biking, or aerobic water exercises.

Be an advocate for the elderly.

Promoting health and well-being is the essential cornerstone of nursing an elderly patient. Once you understand the overall effects of chronic pain in older adults, you can identify patients with debilitating chronic pain more efficiently, collaborate with a multidisciplinary medical healthcare team, and implement needed interventions to offer relief and improve quality of life.

It would help if you constantly stay up-to-date on the latest studies, research, and chronic pain findings. You can use the information from the reports to help guide your practice. Provide measures that promote document patient outcomes, promote comfort, and advocate for elderly patients.

You may urge the nursing leaders to pitch the federal government to fund research concerning chronic pain in the elderly and assist researchers in data collection as appropriate. Remember that pain is not a regular part of aging and older adults also deserve pain relief and the stress pain creates.