Older and younger adults in pain management programs in the United States: Differences and similarities

Wittink, Harriët; Rogers, William H.; Lipman, Andrew; McCarberg, W.; Ashburn, Michael A.; Oderda, Gary M.; Carr, Daniel B.

doi:10.1016/j.jpain.2005.01.286

Cited by 19 publications

(27 citation statements)

References 33 publications

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“…Also, gynecological status was not done systematically to reveal other undetected disorders [30]. However, the risks of other co-morbidity, common among older patients [43], were reduced by choosing a young study population with previous doctor contacts. With this in mind, the results should be interpreted with caution and the results cannot be generalized but probably possible to transfer to similar patient populations.…”

Section: Discussionmentioning

confidence: 99%

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Löfvander

Taloyan

2007

Eur Spine J

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The aim of this study was to explore if self-rated pain intensity and severe pain differed significantly between immigrants from different regions, and if other socio-economic, or clinical, characteristics could predict severe pain. A total of 129 men and 217 women at a primary health centre in Stockholm, Sweden, 27-45 years, on long-term sick leave, were recruited in consecutive order and grouped into a Turkish (n = 122), Southern European (n = 52), Middle East (n = 69) and one Mixed (n = 173) group of immigrants. All were employed in service jobs. Somatic status, depression and level of psychosocial stressors, including pain anxiety, were established by standardized procedures. All reported long-standing disabling back pain. Patients rated intensity of pain ''right now'' on a 0-100 mm visual analogue scale (VAS) as a last part of the consultation with two doctors. Severe pain was defined as VAS 75-100. Median values (md) with inter-quartile ranges (IQR) were calculated for interval and ordinal data. Non-parametric statistics were used to calculate significant differences between groups. Crude and age-standardized odds ratios (OR) with 95% confidence intervals (95% CI) as rating severe pain were calculated by binary and forward conditional logistic regression. Men and women were analyzed separately. Women had more tender points, (P \ 0.001), and reported pain anxiety more often (P \ 0.01). Frequency of depression did not differ between the immigrant groups. The VAS-values varied, but not significantly, between the immigrant groups of men and women. Men had lower VAS values than women (md 50, IQR 36-69 vs. md 72, IQR 51-85), (P \ 0.001). Women had a three-fold risk to rate severe pain (OR 2.9, 95% CI 1.8-4.7). By sex, no immigrant group had significantly elevated OR to rate severe pain. Being 40-45 year old doubled the OR as rating severe pain. Men with depression, or little education, had high risks as rating severe pain (age-standardized ORs 4.1; 95% CI 1.7-10.0 and 2.7; 95% CI 1.1-6.8, respectively), and so had depressed women (age-standardized OR 1.9; 95% CI 1.1-3.4). Women with pain anxiety had a doubled, not statistically significant, elevated risk (age-standardized OR 2.0, 95% CI 0.95-4.3). The groups did not differ significantly in pain intensity or severe pain. Severe pain was predicted by depressed mood and probably linked to gender, age and sick roles.

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Section: Discussionmentioning

confidence: 99%

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Löfvander

Taloyan

2007

Eur Spine J

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“…There are data to suggest that older people with chronic pain appear at disproportionately low rates in specialty pain services (8,9). Just under 3%, or 14 out of 470, of patients attending a specialty service for pain in the UK were over 65 (8).…”

Section: Introductionmentioning

confidence: 99%

“…Just under 3%, or 14 out of 470, of patients attending a specialty service for pain in the UK were over 65 (8). There are also data to suggest that older adults seeking specialty services for chronic pain may differ from younger adults, for example, in having greater physical and fewer psychosocial problems (9).…”

Section: Introductionmentioning

confidence: 99%

Treatment of Chronic Pain for Adults 65 and Over: Analyses of Outcomes and Changes in Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy (ACT)

Scott

Daly

et al. 2016

Pain Med

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Objective: The purpose of this study was to examine the effectiveness of Acceptance and Commitment Therapy (ACT) for older adults with chronic pain. Secondarily, we examined the associations between changes on processes of psychological flexibility and treatment outcome variables.Subjects: Participants were 60 adults with chronic pain aged 65 and older selected from a larger consecutive sample of 928 adults of any age. All participants had longstanding pain that was associated with significant distress and disability.Methods: Participants completed measures of pain, functioning, and depression, and processes of psychological flexibility at baseline, immediately post-treatment, and at a nine month follow-up. Treatment consisted of a two or four week residential program based on principles of ACT delivered by an interdisciplinary team. Treatment was designed to increase daily functioning by enhancing key processes of psychological flexibility, including openness, awareness, and committed action.Results: Participants showed significant improvements in functioning and mental health at posttreatment. Participants also showed significant increases in pain acceptance and committed action from pre-to post-treatment. Small effect sizes were observed for most treatment outcome and process variables in the pre-treatment to follow-up intervals; however, these improvements were not statistically significant. In secondary analyses, changes in facets of psychological flexibility were significantly associated with improvements in social functioning and mental health.Chronic pain in older adults 3Conclusion: This study supports the potential effectiveness of ACT for chronic pain among older adults. Future research is needed to determine how to maximize the impact of this treatment, particularly through greater impact on psychological flexibility.

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“…32 37 The relationship between these physiological changes observed in the laboratory and clinical pain states is unknown, 37 although data suggest that older adults with persistent pain may function at a higher psychological and physical level than their younger counterparts. 118 …”

Section: Age-associated Changes In Pain Processingmentioning

confidence: 99%

“…Many older adults have excellent coping skills and live with persistent pain that is not disabling. 118 Some individuals such as those who suffer from comorbid dementia and/or depression, however, may experience behavioural changes including decreased ability to cope with pain, impaired ability to effectively express needs and distress, and difficulty with adhering to an analgesic or other somatic regimen.…”

Section: Age-associated Brain Changesmentioning

confidence: 99%

Advances in understanding the mechanisms and management of persistent pain in older adults † †This article’s contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources (NCRR) or the National Institutes of Health (NIH). Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-tr

Karp

Shega

Morone

et al. 2008

British Journal of Anaesthesia

109

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Older adults with persistent pain are not simply a chronologically older version of younger pain patients. Pain-related disability in older adults may be driven by pain 'homeostenosis', that is, diminished ability to effectively respond to the stress of persistent pain. Some of the comorbidities of ageing that can contribute to pain homeostenosis include cognitive and physical impairments, increased sensitivity to suprathreshold pain stimuli, medical and psychological comorbidities, altered pharmacokinetics and pharmacodynamics, and social isolation. A key distinction between older and younger individuals with persistent pain is the normal and pathological ageing-associated brain changes. These may alter the expression and experience of pain with impaired descending inhibition and dysfunction of pain gating mechanisms. Cognizance of these brain changes is needed to guide appropriate evaluation and treatment approaches. This paper reviews data that support these ageingassociated phenomena. Specifically, we discuss age-related changes in the brain (both normal and pathological) and in pain physiology; changes in experience and expression of pain that occur with dementia and contribute to pain homeostenosis; and unique aspects of age and pain-associated psychological function and their contribution to disability. We also present data demonstrating changes in brain morphology and neuropsychological performance that accompany persistent nonmalignant pain in older adults and the treatment implications of these brain changes. Finally, preliminary data are presented on the efficacy of mindfulness meditation, a treatment that has been examined explicitly in older adults and targets optimizing brain function and descending inhibition.

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Older and younger adults in pain management programs in the United States: Differences and similarities

Cited by 19 publications

References 33 publications

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Pain intensity and severe pain in young immigrant patients with long-standing back pain

Treatment of Chronic Pain for Adults 65 and Over: Analyses of Outcomes and Changes in Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy (ACT)

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