Problemfelder in der Schmerzmessung und Schmerztherapie im Alter

Abstract

Due to complex physical and psychological changes in aging, pain measurement and therapeutic treatment of older and geriatric patients present a special challenge. Nevertheless, even for this category of patients, good treatment results are achievable if age-related particulars and problems are consistently heeded and accounted for. That includes adverse sensory and cognitive effects as much as multimorbidity and the polypharmacy that is frequently related to it. An essential prerequisite for adequate pain therapeutic care in elderly patients is consistent pain measurement. While numerical and verbal scales have also proven their usefulness for patients in advanced age who are not cognitively impaired, instruments must be applied for older people with communicative and/or cognitive restrictions with which the observed behavior of those involved can be surveyed in a multidimensional way.

Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome

“…No significant differences were found, which was surprising [14] given that previous findings report older patients to benefit less from psychotherapeutic treatments [5,15]. Neither diagnosis nor gender influenced treatment efficacy in terms of depressive symptom reduction.…”

“…Further reasons for an impeded access to possible underlying psychological causes is an inability to perceive as well as tolerate emotions, an incapacity for introspection, or past experiences of rejection, which may distort the therapeutic relationship in the here-and-now. Older individuals seem to have greater deficits and fewer possibilities to verbalize their experiences in this area [5]. To our knowledge this clinical finding has only been analysed and shown in older patients [5], but no comparison between younger and older patients has been done within a psychosomatic inpatient treatment model.…”

“…Older individuals seem to have greater deficits and fewer possibilities to verbalize their experiences in this area [5]. To our knowledge this clinical finding has only been analysed and shown in older patients [5], but no comparison between younger and older patients has been done within a psychosomatic inpatient treatment model.…”

How is the experience of pain measured in older, community-dwelling people with osteoarthritis? A systematic review of the literature

“…Pain assessment tools should be carefully chosen when designing research in older populations due to the specific characteristics of the older population (31,42). The WOMAC has been the most extensively used disease specific outcome measure used in older rheumatological populations, and this was the case in this systematic review in which five studies used it (8,13,35,59,60).…”

“…Pain is a very common experience for older people (36)(37)(38)(39)(40), and pain from osteoarthritis is a significant cause of pain in this population (41). Pain assessment in this group may be further complicated by specific contextual factors of the older person, including communication difficulties, cognitive and sensory impairment, functional disability, multimorbidity and polypharmacy (31,42). Thus, while there is an identified need for comprehensive assessment of the multi-dimensional experience of pain in older people with osteoarthritis, pain assessment tools must be carefully chosen when they are to be used by older people (31,43).…”