Under Treatment of Pain in the Elderly - Essay Example

?Under Treatment of Pain in the Elderly Older adults are more likely to suffer from pain and most often they are undertreated because they hesitate in sharing their problems with their family or doctors. Also, in the elderly, the cause of pain is often not explicit because pain might be occurring due to damage in nerves, tissues or some internal organs. People assume that the feeling of pain in the elderly is part of a natural process of aging since growing age tends to bring with it more diseases and health related problems. This assumption leads to under treatment of pain in the elderly. Pain is not to be regarded as something normal because it always points to the occurrence of some illness no matter what the age. Roy and Thomas (1986) conducted a survey regarding chronic pain in the elderly. They conducted their study on 132 participants who were either residents of the nursing home or were attending hospital programs. They found that 83% of the patients stated that they, most of the time, suffered from pain which mainly was due to damage in connective tissue. 84% of the participants who reported pain were using analgesics and 16% were not receiving any kind of treatment at all. The participants reported that they had been feeling pain for many years. Researchers found that majority of participants reported low levels of pain accompanied with depression, and none of the participants was being treated for depression. According to the researchers, “there may be an inclination to underestimate the prevalence and intensity of pain in the elderly” (p.513). Bernabei et al. (1998) studied the treatment of pain and pain management in the elderly patients who were suffering from cancer and were admitted in nursing homes. Theirs was a retrospective, cross-sectional study conducted in 1492 nursing homes located in 5 different states. The population size was 13625 and the participants were 65 years and older. They found that among the total population size, 4003 patients were those who reported daily, regular pain 16% of whom were receiving a WHO level 1 drug, 32% were receiving a WHO level 2 drug, and 26% were those who were being treated with morphine only (p.1880). They also found that as the age grew older, the opportunities for pain treatment became fewer so much so that the patients who were over 85 years did not even receive an analgesic dose. Their study concluded that “Daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients” (p.1877). Ahmad and Goucke (2002) conducted their research on the treatment of neuropathic pain in the elderly and pain management strategies. According to them, neuropathic pain is the hardest to identify and manage in the elderly without inflicting any adverse effects on them, and this leads to its undertreatment. They state that it is important to incorporate non-drug pain management options in the treatment process to reduce the adverse effects that medication inflicts on the elderly. These options may include psychotherapies, exercises, improved life style, and environmental modification. According to them, combined strategies and mixed treatments can prove to be more helpful in treating pain in the elderly. Gagliese and Melzack (1997) also support the fact that the older adults usually receive inadequate pain management. They state there can be three reasons for this: “lack of proper pain assessment; potential risks of pharmacotherapy in the elderly; and, misconceptions regarding both the efficacy of non-pharmacological pain management strategies and the attitudes of the elderly towards such treatments” (p.3). Supporting the fact that pain treatment becomes less likely because the elderly do not express their pain, there is a research by Manfredi et al. (2002) who studied assessment of pain through facial expressions in the elderly suffering from dementia. They evaluated 9 patients who had “decubitus ulcers associated with reports of pain during dressing changes” (p.48) but could not communicate effectively. Their facial expressions were videotaped before and after the dressing changes which were then shown to 18 professionals to observe if they could assess pain from the facial expressions. The study concluded that facial expressions were an effective means for pain assessment in the elderly especially those who could not report the pain verbally. Barkin, Barkin and Barkin (2005) conducted a study on pain assessment and treatment in the elderly and found that 50% of the elderly were suffering from pain, 80% of whom were suffering from at least one pain difficulty. The researchers also found that it was hard to detect pain in the elderly due to “social, emotional, cognitive, and subjective issues” (p.465) which made pain treatment difficult. Vecchio et al. (1995) surveyed 136 elderly patients with shoulder pain. After three years, only 108 of them were available for re-examination. They found that most of them had persisting pain and symptoms which led to the conclusion that the patients who were receiving treatment were no better than those who did not receive any treatment. The reason might have been an inefficient treatment process. Cleeland (1998) conducted a study on older cancer patients and found that “A leading indicator of inadequate pain management is the poor control of cancer pain” (p.1914). They found that a significant number of elderly patients were being undertreated. A supporting research comes from Davis and Srivastava (2003) who stated that the occurrence of pain increases with age and generally this pain is poorly controlled and poorly treated in the elderly. They asserted that it is important to notice that in the elderly, the aim of treatment is reduction of pain because it cannot be completely eliminated at that stage. Landi et al. (2001) analyzed 3046 elderly participants from 12 health care agencies to identify the occurrence of daily pain and its treatment. They found that 1341 patients reported daily pain 25% of whom were those who received a WHO level 1 drug; 6% received a WHO level 2 drug; and, 3% received a WHO level 3 drug. They found that “85 years or older were less likely to receive analgesics” and the reason for this was their reduced cognitive performance (p.2721). References Ahmad, M, & Goucke, C. (2002). Management strategies for the treatment of neuropathic pain in the elderly. Drugs and Aging, 19.12, pp.929-945(17). Barkin, R.L., Barkin, S.J., & Barkin, D.S. Perception, assessment, treatment, and management of pain in the elderly. Clinics in Geriatric Medicine, 21.3, pp. 465-490. Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R., Lipsitz, L., Steel, K., & Mor, V. (1998). Management of pain in elderly patients with cancer. The Journal of the American Medical Association, 279.23, pp. 1877-1882. Pain, 70.1, pp. 3-14. Cleeland, C.S. (1998). Undertreatment of cancer pain in elderly patients. The Journal of the American Medical Association, 279.23, pp. 1914-1915. Davis, M.P., & Srivastava, M. (2003). Demographics, assessment, and management of pain in the elderly. Drugs and Aging, 20.1, pp. 23-57(35). Gagliese, L., & Melzack, R. (1997). Chronic pain in elderly people. Landi, F., Onder, G., Cesari, M., Gambassi, G., et al. (2001). Pain management in frail, community-living elderly patients. Archives of Internal Medicine, 161.22, 2721-2724. Manfredi, P., Breuer, B., Meier, D.E., & Libow, L. (2002). Pain assessment in elderly patients with severe dementia. Journal of Pain and Symptom Management, 25.1, pp.48-52. Roy, R., & Thomas, M. (1986). A survey of chronic pain in an elderly population. Can Fam Physician, 32, pp. 513-514,516. Vecchio, P.C., Kavanagh, R.T., Hazleman, B.L., & King, R.H. (1995). Community survey of shoulder disorders in the elderly to assess the natural history and effects of treatment. Ann Rheum Dis, 54, pp. 152-154. Read More