Is all pain is treated equally? A multicenter evaluation of acute pain care by age

Hwang, Ula; Belland, Laura; Handel, Daniel A.; Yadav, Kabir; Heard, Kennon; Rivera-Reyes, Laura; Eisenberg, Amanda; Noble, Matthew J.; Mekala, Sudha; Valley, Morgan; Winkel, Gary; Todd, Knox H.

doi:10.1016/j.pain.2014.09.017

Cited by 32 publications

(27 citation statements)

References 23 publications

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“…This might be due to poor quality of life and increased probability of physical disability in older people [28]. Although almost all findings in the clinical literature are consistently pointed towards an increase in clinical pain with age [2,24,29,30], the effects of aging on pain perception remain unclear [16].…”

Section: Age Differences In Clinical Painmentioning

confidence: 99%

Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review

Eltumi¹,

Tashani²

2017

TOPAINJ

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Introduction:An increasing body of literature on sex and gender differences in pain sensitivity has been accumulated in recent years. There is also evidence from epidemiological research that painful conditions are more prevalent in older people. The aim of this narrative review is to critically appraise the relevant literature investigating the presence of age and sex differences in clinical and experimental pain conditions. Methods:A scoping search of the literature identifying relevant peer reviewed articles was conducted on May 2016. Information and evidence from the key articles were narratively described and data was quantitatively synthesised to identify gaps of knowledge in the research literature concerning age and sex differences in pain responses. Results:This critical appraisal of the literature suggests that the results of the experimental and clinical studies regarding age and sex differences in pain contain some contradictions as far as age differences in pain are concerned. While data from the clinical studies are more consistent and seem to point towards the fact that chronic pain prevalence increases in the elderly findings from the experimental studies on the other hand were inconsistent, with pain threshold increasing with age in some studies and decreasing with age in others. Conclusion:There is a need for further research using the latest advanced quantitative sensory testing protocols to measure the function of small nerve fibres that are involved in nociception and pain sensitivity across the human life span. Implications:Findings from these studies should feed into and inform evidence emerging from other types of studies (e.g. brain imaging technique and psychometrics) suggesting that pain in the older humans may have unique characteristics that affect how old patients respond to intervention.

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Section: Age Differences In Clinical Painmentioning

confidence: 99%

Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review

Eltumi¹,

Tashani²

2017

TOPAINJ

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“…This was a retrospective review of data from a multicenter cohort of 1,782 patients collected by Hwang et al for a study on age-related disparities in emergency department pain care [7]. The original study by Hwang et al found no age-related disparities in differences in fracture pain care.…”

Section: Design and Settingmentioning

confidence: 99%

“…This study received institutional board approval with a waiver of informed consent at all five sites. Further details about the sample assembly can be found in the original paper by Hwang et al [7].…”

Section: Design and Settingmentioning

confidence: 99%

“…Fractures are the second most commonly presenting pain syndrome to the ED for older patients, and are associated with high morbidity and mortality [7]. Pain control is especially important in patients with fractures, as poorer pain management has been linked closely with functional decline in the elderly [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…The few studies on fracture pain care in the ED have been limited to a single center and single fracture type, have had a small cohort, and/ or were poorly controlled for confounders [5,10,[12][13][14]. A recent multicenter study by Hwang et al in 2014 [7] on all fractures made the surprising discovery that older patients with fractures were more likely to receive analgesics and opioids, and had better self-reported pain outcomes than younger patients. Hwang et al posited that the difference in pain care may be driven by the greater prevalence in the elderly of LBF, which may elicit more aggressive pain treatment than other types of fractures.…”

Section: Introductionmentioning

confidence: 99%

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A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

et al. 2016

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Objectives. To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients.Design. Secondary analysis of retrospective cohort study. Measurements. Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type.Results. A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR 5 2.03; 95 CI 5 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate 5 0.268; 95 CI 5 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55-163] vs. 76 [35-149] minutes, P 5 0.057), but no other differences in process outcomes were found.Conclusion. Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.

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Management of Acute Postoperative Pain in the Geriatric Patient

Spalding¹,

Berger²

2018

Principles and Practice of Geriatric Surgery

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Is all pain is treated equally? A multicenter evaluation of acute pain care by age

Cited by 32 publications

References 23 publications

Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review

Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures

Management of Acute Postoperative Pain in the Geriatric Patient

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