Chronic Pain Control for the Older Adult

The Problem of Chronic Pain

In a survey cited by The American Chronic Pain Association, 34% of senior citizens reported that they suffer from daily pain. Another 12% of respondents experience pain on a weekly basis. Ever-increasing pain in the bodies of our elderly population is often considered a normal and unavoidable part of the aging process, but the discomfort of your senior loved one is not a problem that should be tolerated or ignored. With proper pain prevention and treatment, our precious elders can live dignified and productive lives.

Effective pain management is a crucial component to caring for the elderly, because chronic pain can affect so many areas of a senior’s life. When a person is in pain, he or she finds it difficult to enjoy what would normally be happy experiences. This loss of enthusiasm can easily lead to depression and an increase in mental impairment. Additionally, chronic pain opens the door to further injuries and discomforts. For example, a 2009 study published by The Journal of the American Medical Association found that the fall risk for adults over the age of 70 increases by as much as 77% when the individual suffers from chronic pain, especially when the soreness occurs in their joints.

Chronic pain not only interferes with the quality of a senior’s life, but it also pays a toll on the personal relationships of the individual. Nobody likes to watch their loved one suffer through pain! Friends and family members of a person in chronic pain may find themselves taking on a role of caregiver, which can cause unnecessary stress for everybody involved. Pain prevention and management is the key to your loved one’s ability to maintain strong interpersonal relationships and to lead a healthy and happy lifestyle.

Preventing Chronic Pain

The first step to controlling chronic pain is to stop the problem from ever developing.The best way to achieve this goal is through establishing a pattern of healthy living. Encourage your loved one to eat well, get enough sleep and to exercise his or her body in order to keep everything in optimal working condition. Take steps to prevent illness, such as using doctor-recommended vitamin supplements and keeping vaccinations up-to-date.

Even while maintaining an active and healthy lifestyle, older adults cannot always avoid injury or sickness. When temporary pain occurs, it is important to treat it immediately and effectively. There are neurons in the spinal cord that are designed to prevent pain transmissions, and medical researchers have discovered that it is possible for these neurons to weaken, while the neurons that transmit pain become more sensitive to stimuli. The study of neuroplasticity teaches us that it is possible for bouts of severe pain to be encoded into an individual’s memory and develop into a persistent condition. The less pain your loved one must endure at any given time, the better, so be sure that pain management is a top priority after surgeries or in other painful situations.

Recognizing and Assessing Chronic Pain

It is important to distinguish between the two major forms of pain – acute and chronic. Acute pain results from an obvious and recent injury, and is temporary in nature, while chronic pain is long-lasting. However, it is important to treat acute pain immediately, and to take all pain seriously, even if you or your loved one suspects that it may go away naturally over time.

As an advocate for your loved one, it is important to recognize when an elderly individual is suffering from chronic pain, even if he or she does not complain about discomfort. There are many reasons why a senior family member might keep his or her pain a secret. Reasons for hiding pain may be as simple as an elderly person not wishing to appear weak or the fear of becoming a burden on others, but in some cases, such as a senior suffering from dementia, your loved one may not be able to express his or her condition in words. This is why vigilance and careful observation is so important!

Here is a TED video discussing chronic pain. Although the case discussed here is pediatric, the points made are general to pain management.

Watch for Signs

When spending time with your elderly loved one, watch for subtle signs of pain such as grimacing facial expressions, the rubbing of aches, or restrictions in movement. Observing body language can give you a reliable assessment of how your family member is feeling, as can watching for changes in typical behavior. For example, if Grandma suddenly loses interest in her beloved afternoon talk shows, it could be a sign that sitting in one place for several hours has become too painful for her to endure.

Signs of pain in older adults with dementia include:

  • Facial expressions that indicate pain, such as frowning, looking frightened, grimacing, keeping eyes tightly closed, rapid blinking
  • Moaning, groaning, sighing, grunting, chanting, calling out or calling for help, breathing noisily, being verbally abusive
  • A rigid, tense body posture, fidgeting, pacing, rocking or changes in walking or movements
  • Changes in eating or sleeping habits or in usual routines
  • Increased confusion, irritability, distress or wandering

Ask Questions

The first step in evaluating the location and severity of your loved one’s pain is to simply ask. When approached with concern and sensitivity, even a reluctant sufferer will likely be willing to talk about his or her areas of discomfort. In order to provide the best information when discussing issues of pain with your loved one’s health care team, try to establish:

  • Where the trouble is occurring?
  • When does it feel better/worse?
  • What activities cause the hurt to flare up?

It is helpful to learn the terminology for different types of pain—such as “aching,” “stabbing,” “burning,” etc. —to assist the doctor in diagnosing chronic pain correctly.

Keep Track of Pain

Tracking levels of daily pain in a diary or journal can also provide valuable information for medical staff. If your loved one is unable to undertake this task, it is easy for a caregiver to keep records on his or her behalf. The Partners Against Pain website contains comprehensive tools for measuring and tracking pain, along with providing useful resources for caregivers.

Treating Chronic Pain with Medications

Pharmaceutical pain management is often the first course of action when treating seniors with chronic conditions. Medications should always be taken under the supervision of a doctor, particularly in elderly patients where additional precautions apply. Despite potential side effects, the American Geriatrics Society assures us that “Although older patients are generally at higher risk of adverse drug reactions, analgesic and pain-modulating drugs can still be safe and effective when [co-existing medical conditions] and other risk factors are carefully considered.”

Common medications for pain control include:

  • Non-opiate pain reducers – acetaminophen, etc.
  • Opiate pain reducers – oxycodone, morphine, etc.
  • Anti-inflammatories – ibuprofen, aspirin, etc.
  • Corticosteroids – prednisone, etc.
  • Muscle relaxers – tramadol, diazepam, etc.
  • Topical pain reducers – lidocaine, capsaicin, etc.

It is not uncommon for anti-depressants and other psychiatric medications to be prescribed for the purpose of managing pain, even in seniors who have no symptoms of poor mental health. This is because the chemicals that influence mental disorders are often same ones that can relieve pain when their production is increased through medication.

For optimal results, your loved one should take his or her pain medication exactly as prescribed by the overseeing physician. Always take the doctor’s instructions and advice to heart, but also encourage elderly family members to ask questions and voice concerns about their care. While clinical staff are trained professionals and worthy of trust and respect, your loved one is the top expert on his or her own body and should feel comfortable speaking up when pain treatment is not working as designed.

In seniors with a history of severe chronic pain, drug side effects can be drastically reduced by the surgical installation of an intrathecal pump to deliver a low dose of medication directly into the spinal cord. This form of intake is highly effective, but comes with its own unique risks to the patient.

Alternative Treatments for Chronic Pain

If medication is ineffective for controlling chronic pain in your senior loved one, all hope is not lost. Ask medical staff about any alternative treatments or procedures that may be available to provide relief for persistent pain. New technologies are always in development for targeting soreness in specific areas of the body or even to manage generalized pain. Some of the latest options for pain treatment in the elderly are:

  • Steroid injections – Given in an aching joint or as an Epidural in the spine, these injections can provide short-term pain relief lasting from one to three weeks.
  • Spinal cord stimulator – A generator is surgically implanted inside the person’s body, and is programmed to shoot pulses of electricity into the spinal cord to disrupt pain transmitting neurons.
  • Nerve blocks – Doctors can use radio frequency or x-ray waves to kill the specific nerves that are identified as causing a person’s pain.

These aggressive and invasive treatments typically require the involvement of a specialized pain management clinic.

Integrative Care

Some seniors, whether by choice or necessity, explore holistic therapies for chronic pain control. These techniques are often termed as “integrative care,” and many focus on learning to live more comfortably with pain, rather than attempting to eliminate it.

Integrative care techniques include:

  • Massage therapy
  • Acupuncture
  • Hypnosis
  • Meditation
  • Aromatherapy
  • Cognitive Behavioral Therapy
  • Biofeedback
  • Herbal supplements

Resources for Persistent Pain Management

The following organizations can provide helpful information about persistent pain relief in older adults:

  • American Chronic Pain Association
    P.O. Box 850
    Rocklin, CA 95677
    916-632-0922
    www.theacpa.org
  • American Pain Society
    4700 W. Lake Ave.
    Glenview, IL 60025
    847-375-4715
    www.ampainsoc.org
  • Arthritis Foundation
    1330 W. Peachtree
    Atlanta, GA 30309
    (800) 283-7800
    www.arthritis.org
  • American Pain Foundation
    201 North Charles Street, Suite 710
    Baltimore, Maryland 21201-4111
    (888) 615-7246
    www.painfoundation.org
  • National Center for Complementary and Alternative Medicine (NCAM)
    P.O. Box 7923
    Gaithersburg, MD 20898
    1-888-644-6226
    TTY: 1-866-464-3615 (for hearing impaired)
    www.nccam.nih.gov
  • National Chronic Pain Outreach Association (NCPOA)
    7979 Old Georgetown Road, Suite 100
    Bethesda, MD 20814-2429
    (301) 652-4948

 Written by senior care writer Mack Fritch.