Pain is common in the elderly patient, but it is greatly undertreated. Proper pain management can be complicated and can require a multitude of treatment options and modalities. Pain is the most common reason for physician visits annually. As the U.S. population ages, this number is projected to rise. The physicians at Roswell Pain Specialists are fully equipped for diagnosing and treating pain in elderly patients. Schedule your appointment now by clicking here.
Although it is clear that the elderly experience pain, they are often undermedicated because of the concerns for oversedation, decreased drug clearance, and the risk of drug-drug interactions.4 A study of acute burns showed the effects of age on narcotic dosing. In this study, patients over 75 years of age received significantly less opioid medications than patients age 66-75 years, who received less medication than patients age 55-65 years. Concerns of drug toxicities, drug interactions, and the patients’ fears of pain management are all factors in treating the elderly patient with pain, but these do not have to be barriers to effective pain management.
The Role of the Physician in Geriatric Pain Management
The role of the physician becomes increasingly important as mean survival rates increase and federal funding and access to healthcare decreases. The role of the physician in managing geriatric pain is outlined as follows:
- Diagnose pain syndromes. Physicians are apt to be more aggressive in treating pain when they have a known diagnosis.
- Rule out life-limiting and life-threatening pain syndromes appropriately.
- Screen for pain, depression, and drug and alcohol abuse, and refer the patient to the appropriate treatment professional.
- Perform a functional status assessment. If the patient is hospitalized, assist him/her and/or the caregiver(s) in making decisions about returning home or entering a long-term care facility.
- Determine what additional support systems are needed, such as physical and occupational therapy services, a home health aide, or hospice services.
- Provide for assistive and adaptive equipment such as canes, walkers, wheelchairs, and orthotics. Adaptive equipment can markedly improve the function of the elderly pain patient.
In managing difficult geriatric pain syndromes, a team of healthcare professionals is required. The primary team consists of the primary care physician/geriatrician, pain management specialist, physical medicine and rehabilitation specialist, and occupational and physical therapists. Additional consultations may be required from a neurologist, neurosurgeon, orthopedic surgeon, gastroenterologist, psychologist, and drug and alcohol detoxification specialist.
Assessment of Pain in the Elderly
The initial treatment of pain begins with a thorough history and physical examination. A detailed history should include a description of pain characteristics, with specific inquiries on thyroid disease, hepatic and renal disease, diabetes mellitus, gastrointestinal disorders, psychological disorders, infectious disease, rheumatologic disease, and neurologic disease. Infectious diseases include Lyme disease, shingle infections, and meningitis. Rheumatologic disorders include rheumatoid arthritis, osteoarthritis, fibromyalgia, and osteoporosis. Neurologic review includes cerebrovascular accident, polio, and neuropathies. A review of any trauma or falls should be a routine part of every evaluation.
Since pain and suffering are subjective and individual to the patient, objective assessment can be difficult. Several pain scales exist to help to provide a quantitative estimate of the intensity of the patient’s pain. Visual analog scales, numerical scales, and verbal descriptive scales are widely used to evaluate pain in geriatric patients.