Pain is one of the most complex symptoms to treat. Sufferers aren't always able to pinpoint exactly where they hurt, making the diagnosis and treatment tricky. For elders living with chronic pain and their caregivers, managing pain sometimes seems like a hit or miss proposition, and it may take several types of treatments and even several different doctors before finding true relief.
Understanding pain
By definition, chronic pain lasts longer than the typical healing process. For some patients that may be a few weeks, for others it may be three to six months or longer, depending on the injury. In elderly patients, pain can manifest in different ways.
"An 80-year-old may equate pain with their age," says Dr. Cary Reid, a geriatrician at Weill Cornell Medical College in New Haven, CT. However, Dr. Reid adds there is no evidence to prove that people become less tolerant to pain as they grow older, although symptoms may show up in differently in an older patient, and they have a variety of additional concerns a younger patient may not have. Many elder patients fail to seek pain relief because they worry about the consequences of treatment, side effects or the cost of medication.
However, there many reasons why patients to try to deny it or at least under report it.
Older adults believe pain is a sign of vulnerability. What Dr. Cary Reid notices most in treating his elderly patients is what he calls an ‘ageist" attitude that many patients, caregivers, health care professionals and even physicians have towards pain. It's one of the reasons he believes elders and caregivers aren't more rigorous in seeking relief. "We have to educate patients, their adult children (who are often caregivers) and their providers that patients don't have to suffer."
Dr. Niharika Suchak, associate professor of geriatrics at Florida State University College of Medicine believes healthcare professionals should ask and evaluate pain at each encounter, similar to checking vital signs such as blood pressure, pulse, respiratory rate and temperature. "Though pain is a subjective symptom, some healthcare organizations have termed pain as the ‘fifth vital sign' to emphasize the importance of identifying, evaluating and treating pain."
One way that pain appears to be evident in older patients is that they may become disoriented or confused in pain, or their mental state may become altered, according to Dr. Keith Candiotti, professor of anesthesiology and internal medicine at the University of Miami School of Medicine, so caregivers and healthcare professionals should be on the lookout for these symptoms.
Social withdrawal and depression are additional ways that pain appears to manifest differently in older patients. "Pain in the elderly can be more devastating or severe because they tend to feel more isolated, helpless or hopeless compared to others," says Dr. John F. Dombrowski, who practices at the Washington Pain Center in Washington, D.C. For those patients, finding a physician who understands their condition and is committed to treating the whole person is paramount.
Pain options and alternatives
Chronic pain that is mild to moderate can often be managed with over-the-counter medications like acetaminophen (Tylenol) or naproxen sodium (Aleve). Non-steroidal drugs are the next level of pain relief intended for short-term use because they can cause high blood pressure and an increased chance of stroke and/or heart attack. If pain still persists, opiates can be effective, but many elders stop using them because of side effects such as constipation, nausea, itching, fatigue and what some call ‘mental cloud.' Many patients and caregivers worry about the possibility of addiction, as well. Pain blockers and injections can also be useful in "providing targeted relief without the need for regular medication" notes Dr. Dombrowski.
"The medications we have for the treatment of pain aren't great," admits Dr. Reid. "So it's important to think about multiple ways to deal with pain and find other strategies." He suggests:
- Hot and cold therapy – treat the area with a heating pad, followed by ice pack to reduce inflammation and pain
- Keeping physically active through exercise or movement routines such as yoga or swimming (elders should check with their doctor before beginning a rigorous exercise routine)
- Physical therapy
- Acupuncture, magnet therapy and hypnosis are other complimentary treatments, which can prove effective and often have no side effects
- Cognitive behavioral therapy, which teaches self-pain management
To broaden what he calls the "portfolio of treatment," Dr. Reid suggests utilizing three to four strategies, which may include medication. Although these treatments often are not covered by insurance, they can be a beneficial out-of-pocket expense in providing relief.
How caregivers can help
Caregivers can help determine if pain is keeping their loved one from enjoying everyday activities, or if there are new or worsening symptoms and/or side effects. Consider keeping a daily diary of your loved one's symptoms to help healthcare providers determine possible patterns or pain triggers.
Secondly, caregivers can serve as the communication conduit between the elder and doctors. Be an advocate for your loved one and don't be afraid to ask questions until you are satisfied. If a doctor brushes off your concerns or doesn't seem interested in getting to the root of a loved one's chronic pain, it may be time to seek out a different physician or a chronic pain specialist.
Dr. Suchak advises caretakers to make sure prescribed medication is being taken as directed, because non-adherence can lead to inadequate pain relief. "In chronic pain, it is important to get ahead of the pain, rather than wait for it to become unbearable," she says.
Finally, caregivers to elders living with chronic pain can serve as cheerleaders, encouraging their loved ones to stay engaged in activities they enjoy. "Do not underestimate the power of distraction," notes Dr. Reid. Keeping active mentally can sometimes relieve pain as effectively as medication. Listen to music or play the piano, watch a favorite movie, do crossword puzzles – whatever keeps you engaged and happy can help provide short-term pain relief. "I tell my patients time and time again that the best analgesic is an occupied mind."
Unfortunately, there are no short-term fixes when it comes to chronic pain and treating it often takes a team approach. Despite all of the complexities, chronic pain can be managed, ensuring that older adults maintain as much function as possible.