A cross-sectional survey of the perspectives of older people in the Scottish Highlands on the management of their chronic pain

Abstract

Background Although there is evidence of suboptimal outcomes in older people with chronic pain, little emphasis has been placed on those in remote and rural settings. Objective To describe the perspectives of older people in the Scottish Highlands on their chronic pain management. Design Cross-sectional survey. Setting NHS Highland, the most remote and rural geographical health board in Scotland. Subjects Home-dwelling members of the public aged ≥70 years. Methods Anonymised questionnaires were mailed to a random sample of 1800 older people. Questionnaire items were demographics, nature of any chronic pain, management regimens and perceived effectiveness. Validated scales were the Pain Disability Questionnaire and the Tampa Scale for Kinesiophobia. Results Adjusted response rate was 39.3% (709/1755). One-quarter (25.0%, n = 177) were experiencing chronic pain, being more likely to live in deprived areas (P < 0.05). Median pain intensity was 6 (IQR 4–7, 10 high), causing distress (median 5, IQR 3–7). Respondents largely consulted GPs (66.1%, n = 117) with a minority (16.4%, n = 29) referred to a specialist pain clinic and few consulting other health professionals. Over three quarters (78.0%, n = 138) were receiving prescribed medicines, most commonly paracetamol, alone (35.6%, n = 63) or in combination with opioids (16.4%, n = 29). One-third (31.6%, n = 56) expressed a desire for more effective medicines; few reported using any non-pharmacological therapies. The median scores for the Pain Disability Questionnaire and Tampa Scale for Kinesiophobia were 74 (IQR 34–104.5, 150 high) and 40 (IQR 35–45, 68 high). Conclusions Evidence of provision of appropriate integrated and person-centred chronic pain care is lacking.

A qualitative exploration of chronic pain management of older adults in remote and rural settings

“…Older adults (defined as those aged 75 years and over) living within remote and rural areas of NHS Highland who are experiencing chronic pain (defined as pain lasting more than 12 weeks) who participated in the previous survey-based research project [ 18 ] and indicated on the questionnaire returned that they were willing to take part in further research were invited to participate in the interviews. Those willing were mailed the participant information sheet and asked to complete a consent form and provide details of the best days and times of the week for the interview.…”

“…Those experiencing chronic pain were significantly higher users of healthcare resources and living in more deprived areas. Pain was most commonly managed by a GP using paracetamol alone or in combination with opioids and other analgesics, with few respondents reporting using non-pharmaceutical therapies [ 18 ].…”