The health care professions are all facing an ageing and rising tide of baby boomers, and many of these patients are going to be suffering from chronic pain, whatever the reason. Unfortunately, the elderly are often untreated or undertreated for pain. Patient and physician should each begin to ask themselves, How can this situation be improved?
Pain is a common complaint of the older patient, and as the population ages, frailty and chronic diseases associated with pain will increase. Older patients are more likely to suffer from arthritis, cancer, and other musculoskeletal disorders. Studies have shown up to 50% of the elderly living in the community have significant pain problems; that number rises to as high as 80% in the nursing home population. Unfortunately, the elderly do not in general have adequate pain treatment, resulting in depression, anxiety, social isolation, cognitive impairment, immobility, and sleep difficulties. Physicians admit to an occasional misinterpretation of the degree of pain in a particular patient, in addition to a reluctance to prescribe opioids, and other medications.
And it is true that older adults are more likely to have an increased risk of adverse reactions to the use of pain medications, this often due to less than perfectly functioning kidneys and livers. Additionally, older adults are more likely to be on a variety of medications for other medical problems, increasing the risk for drug interaction.
Despite this risk of adverse drug reactions, the prescribing of drugs is the chief tool for the treatment of pain. Starting dosages of pain medications should be lower, and the dosages increased slower, in the elderly patient. Anti-inflammatory drugs should be used cautiously, in light of their potential for causing ulcers or kidney disease. Opioid drugs such as morphine and oxycodone are acceptable alternatives; the risk for addiction is fairly low in the older patient. However, constipation is often made worse by opioid drugs, so the prescribing doctor should include stool softeners or other bowel medications to lessen this potential side effect.
Other drugs which are used for chronic pain include antidepressant medications and anti-seizure medications such as Lyrica or Neurontin. I have found Lyrica and Neurontin to be well tolerated drugs in the older patient, and frequently very effective.
But caregivers should not forget the non-pharmacologic treatment of their patients. For example, it is important to educate the patient regarding the nature of chronic pain. It is also important to encourage counseling so that the patient might better deal on a psychological level with chronic pain. Physical therapy can be an important and safe adjunct. And the more religious patient might gain a little bit of pain relief with a few words from the local rabbi, priest, mullah, or Buddhist monk.
Physicians and family members must listen to the elderly, and treat the pain complaints the elderly have. Growing old and having pain should not be an inevitable and chronic misery. The pain the elderly suffer can be treated-it might require a little more caution, and a lot less fatalism.