Caregiver Resources - Pain

Pain is a subjective, unpleasant sensory and emotional experience.(2) Acute pain usually results from trauma or surgery and is time-limited.  Persistent pain lasts for more than 3-6months and is typically found with chronic conditions or injury. This type of pain is associated with functional loss, mood disruptions, behaviour changes, and reduced quality of life.(2) Other categories of pain include nociceptive pain (pain caused by stimulation of specific peripheral or visceral pain receptors) and neuropathic pain (pain caused by damage to the peripheral or central nervous system).(2)

Why is it important?

  • 50% of older adults in community-dwellings and up to 80% of nursing home residents/long-term care residents experience some form of pain (4)
  • Elderly are often untreated or undertreated for pain (1)
  • Consequences of under treatment for pain can have a negative impact on the health and quality of life of the elderly: depression, anxiety, social isolation, cognitive impairment, immobility, and sleep disturbances, impaired immune function and increased dependency (2)(1)

Common Causes

  • Frailty and chronic diseases are prominent among the elderly; they are more likely to have arthritis, bone and joint disorders, cancer, and other chronic disorders associated with pain (1)
  • Other reasons for pain include trauma, injury, and surgery
  • Misbeliefs (e.g. part of old age), hearing loss, vision loss, and cognitive impairment due to dementia or delirium can hinder an older adults attempts at communicating pain severity and duration; therefore, extending the experience
  • Reasons for inadequate pain control include lack of training, inappropriate pain assessment, and reluctance to prescribe medication or treatment, pain management being seen as low priority by health professionals, and lack of time for proper assessment/follow-up (4)(1)

Key Considerations

  • Communication with caregiver or health care team is the best way to help manage or end chronic pain.  Ask the right questions:
    •    What is causing my pain?
    •    What can I do?
    •    What is the pain medication/treatment?
    •    How does it work?
    •    How long do I take it for and do I take it with meals/ is there a schedule?
    •    What are the side effects and does this medication interact with my current medication?
    •    What are expected results? (3)
  • Discuss strategies to minimize pain and its consequences on functioning, sleep, mood, and behavior with health team (2)
  • Discuss possibility of a physical therapy and counseling with family nurse or physician
  • Exercises such as yoga and Tai Chi can help relax muscles and reduce pain

References

1.      Cavalieri, T. (2005). Management of Pain in Older Adults. JAOA, Supplement 1, 105(3), S12-S17. 
         Retrieved March 2014 from:  
         http://www.jaoa.org/content/105/3_suppl/12S.full.pdf+html

2.      Horgas, A., Yoon, S., Grall, M. (2012). Nursing Standard of Practice Protocol: Pain Management in Older Adults.
         Retrieved March 13, 2014 from:
         http://consultgerirn.org/topics/pain/want_to_know_more

3.      National Institutes of Health.  (2011).  Seniors and Chronic Pain. Retrieved March 13, 2014 from:
         http://www.nlm.nih.gov/medlineplus/magazine/issues/fall11/articles/fall11pg15.html

4.      The Canadian Pain Society (2013). Pain in Canada Fact Sheet. Retrieved March 13, 2014 from:  
         http://www.canadianpainsociety.ca/pdf/pain_fact_sheet_en.pdf