Chronic Pain in Older Adults

Bicket, Mark C.; Mao, Jianren

doi:10.1016/j.anclin.2015.05.011

Cited by 73 publications

(54 citation statements)

References 37 publications

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“…Our findings relating to OTC codeine use are consistent with the findings from a community sample of people with chronic non-cancer pain, in that those aged 65 years and over were less likely to use OTC pain medicines compared to adults of working age (19-54 years) p < 0.05, **p < 0.01, ***p < 0.001 NSAIDs: Non-steroidal anti-inflammatory drugs [40]. The higher rates of prescription codeine use reflect the higher prevalence of chronic pain among older adults and that opioids are a key treatment modality in the management of pain [41]. Understanding the long-term effectiveness and risks of opioid use in older adults is therefore becoming increasingly important, particularly as older adults are known to be most susceptible to opioid-related adverse effects due to multiple comorbidities and the concurrent use of other medicines that may cause central nervous system depression [42].…”

Section: Discussionmentioning

confidence: 99%

An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia

Gisev¹,

Nielsen²,

Cama³

et al. 2015

Eur J Clin Pharmacol

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Section: Discussionmentioning

confidence: 99%

An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia

Gisev¹,

Nielsen²,

Cama³

et al. 2015

Eur J Clin Pharmacol

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“…Age-related changes such as a decrease in the transmission speed of nerve impulses, impairment of the inflammatory cascade, and changes in the skin and cortices have been posited as potential causes of age-related changes in pain perception based on laboratory investigations of experimental pain or animal studies [7,18,25,31]. Overall sensory deficits common with advancing age such as vision and olfaction have also been posited as evidence for reduced sensory discriminative abilities [18,25,53].…”

Section: Discussionmentioning

confidence: 99%

“…The effect of aging on pain perception remains an area of contention, but largely evidence suggests that among older adults the pain threshold increases, possibly reflected in a plateau effect in the prevalence of chronic pain in individuals over age 65 years [7,45]. This plateau effect could also represent under-reporting of pain in some elders further complicated by issues of communication barriers, cognitive impairment, or increased stoicism and perceived myths that having pain is a “natural” consequence of aging [23].…”

Section: Introductionmentioning

confidence: 99%

Pain quality descriptors in community-dwelling older adults with nonmalignant pain

Thakral

Shi

Foust

et al. 2016

PAIN

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This study aimed to characterize the prevalence of various pain qualities in older adults with chronic non-malignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Study, 560 participants aged≥70 years reported chronic pain in the baseline assessment, which included a home interview and clinic exam. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 descriptors, from which 3 categories were derived: cognitive/affective, sensory and neuropathic. Presence of ≥2 pain-associated conditions was significantly associated with 18 of the 20 pain quality descriptors. Sensory descriptors were endorsed by nearly all older adults with chronic pain (93%), followed by cognitive/affective (83.4%) and neuropathic descriptors (68.6%). Neuropathic descriptors were associated with the greatest number of pain-associated conditions including osteoarthritis of the hand and knee. More than half of participants (59%) endorsed descriptors in all 3 categories and had more severe pain and interference, and multi-site or widespread pain than those endorsing 1 or 2 categories. Strong associations were observed between pain quality and measures of pain severity, interference, and distribution (p<.0001). Findings from this study indicate that older adults have multiple pain-associated conditions which likely reflect multiple physiological mechanisms for pain. Linking pain qualities with other associated pain characteristics serves to develop a multidimensional approach to geriatric pain assessment. Future research is needed to investigate the physiological mechanisms responsible for the variability in pain qualities endorsed by older adults.

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“…A recent epidemiological study found that the vast majority of patients with pain had a regional pain condition; the study also suggested that future analyses should split this group into two categories, an approach used by a large study from the United Kingdom 33. Few studies have investigated the prevalence of pain spread categories in the elderly, and even fewer studies have performed in-depth analyses of the associations of pain spread 1,10,15,16,34,35…”

Section: Introductionmentioning

confidence: 99%

“…However, the relationship between age and pain remains controversial; some studies demonstrate that pain prevalence decreases with age, while others support an opposing association 10,12,34. Some others, though, suggest that there is no concrete association between pain and age 1,39.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

Dragioti

Larsson

Bernfort

et al. 2016

JPR

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Background and objectiveThere is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects ≥65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden.MethodsSex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%).ResultsRP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all p<0.01). RP-Heavy was less likely in the 80–84 and >85 age groups compared to the 65–69 age group (both p<0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all p<0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all p<0.01). Depressive disorders were associated with all pain categories, except for LP (all p<0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all p<0.05). Medication for peripheral vascular disorders was associated with RP-Medium (p<0.05), and hypnotics were associated with RP-Heavy (p<0.01).ConclusionMore than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults.

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Chronic Pain in Older Adults

Cited by 73 publications

References 37 publications

An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia

An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia

Pain quality descriptors in community-dwelling older adults with nonmalignant pain

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

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