Persons older than 65 years of age are less likely to receive strong analgesics for moderate to severe pain than younger patients complaining of comparable pain, according to researchers at the 2010 Annual Meeting of the American Geriatrics Society (AGS). Specific reasons for this are as yet undetermined.A nationwide study found that strong-opioid therapy was prescribed to 36% of patients aged younger than 65 years, compared with 31% of patients aged 65 to 74 years and 25% of patients 75 years of age or older. Investigator Aarti Patel, PharmD, said during a poster presentation on May 13, 2010, "Results from [a] large national survey suggest that inadequate analgesia and undertreatment of pain are common, particularly among older patients." The survey included responses from nearly 57,000 patients being treated for pain post surgery, osteoarthritis flares, trauma or injury, acute low back pain, acute neck pain, acute shingles, or another acute condition. In each age group about 95% of the patients indicated they were suffering from moderate to severe pain due to the various conditions. Overall, "we observed that the older the patient was, the less likely it was that the patient would receive adequate pain relief," Patel noted. She further said that researchers are now trying to determine the reasons for the under-prescribing of adequate pain relief in the elderly.
COMMENT: In the above study, which was funded by Ortho-McNeil Janssen Scientific Affairs, the greatest absolute risk difference was 11% (36% minus 25%), which may not seem enormous but could account for millions of undertreated elderly persons on a national scale. The American population aged 65 years or older numbered 37 million in 2006 and it is expected to nearly double by 2030. It is well known that poorly controlled pain in older patients can negatively affect quality of life, resulting in depression, sleep disturbance, social isolation, cognitive impairment, and other detriments. At the same time, there have been concerns about strong analgesics incurring greater adverse events in the elderly, so achieving a balance of risks-benefits can be challenging. For the most current guidelines from the AGS on the “Pharmacological Management of Persistent Pain in Older Persons” [click here].
SOURCE:AGS presentation title: The Undertreatment of Moderate to Severe Pain Among Elder and Non-Elderly Patients; Abstract A99. Reported in Doctor’s Guide, May 14, 2010 [available here].
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8 comments:
Whenever anyone has opioids on board, any injury, death, accident is attributed to the pain medications. What evidence is out there that old people fail to develop tolerance to the sedating effects, just as the rest of us do?
The reason old people are left in acute pain as are most people in chronic pain, is that they are seen as less human than people in their prime. Children and babies are also profoundly undertreated for the same reasons...
Siobhan Reynolds
Pain Relief Network
I co-authored a study that was published 17 years ago (Journal of the American Geriatrics Society, 1993;41:541) that found the similar results as this study. Furthermore, we found that impaired ability to communicate was a major factor in geriatric patients being under treated.
Since our study, there have been multiple others demonstrating the same thing: that geriatric pain is frequently poorly managed. I'm not sure why people continue to replicate findings that have long been accepted rather than focusing on improving management.
Steven A. King, M.D.
As always, we appreciate Dr. King’s comments (above). Replication of research is not always a bad thing, as it helps to establish validity of the initial findings. However, we agree, multiple replication without contributing any new insights or hints at a solution to the problem – that seems like a bit of a waste. -- SBL
In regard to the undertreatment of pain amongst the elderly: I believe that doctors are more hesitant to prescribe stronger pain relievers to the elderly as their opinion seems to be that the elderly have less capacity overall to handle opiates, to reduce opiate use once dependant etc. I am also of the belief that elderly patients do not advocate for themselves and most of them have a very difficult time being persuasive with their doctors.
Just as with everything else, the children and elderly patients get treated the worst when it come to relieving their pain. Shouldn't it be a priority to keep our elderly comfortable and our children from being traumatized by pain. Its bad enough that adults have to fight for their own pain to be controlled but to do this to children and elderly is beyond reproach. The vulnerable always get the short end of the stick, its seems.
I wholeheartedly agree with this study. When I have expressed my need for more adequate pain control for DDD in my neck and lower back, I was told that "I seem to be able to do my day to day tasks alright, why up the dose?" What they don't listen to is BECAUSE I am FORCED to do necessary daily routine, I have NO CHOICE but to do these things in pain because they wont listen. This makes it a monumental effort, and when the pain gets so bad it is hard to LOOK at my pain meds and NOT take them for relief more often than prescribed. That leads to accusations of ABUSE rather than indicating inadequate pain control! In other words, I'm damned if I do and damned if I don't. That kind of treatment just leads to more and more depression. Don't say find another doctor, have YOU tried to find a doctor to treat pain recently? It's nearly impossible to find one who will prescribe at all let alone at an adequate level.
This, and several other articles with and without comments, leads me to wonder why we are in so much pain, and is it unique to Americans? Yes, I know, I have more than one physical condition that can be blamed for the pain. But I have had pain all my life, well before any physical complications developed. Because I was a child, my pain was never treated beyond aspirin from my mother; but only when I had a fever too. Tylenol when it was still a prescription medication for the constant headaches. And rheumatism from a babyhood big problem, life threatening, was the explanation given for my early pain; and wintergreen and a heating pad were the methods of pain relief. It was never enough.
Is our pain from factors in our culture that we may be able to change? Do other people in the world have mysterious pain too, once you factor out war, famine and rampant disease? It is becoming more of a problem affecting learning, productivity and creativity and we need to be doing more about it.
Additionally, I am now considered elderly at 72, and will soon be moving. Will that mean automatically that I will have to begin the search all over again for adequate pain management? Not that I found it here; however I recently was sent to a pain management clinic and, if I had more time, it seems as tho they would find a way to reduce my pain with an increased usage of pain meds and other modalities. Sure hope I can find another pain clinic that is so open to recognizing and treating my pain. Helen Mueller
Thank you, for your comments, Helen (immediately above). According to all data, the epidemic of chronic pain is a worldwide problem, not just in the U.S.
If you move, you will probably need to find a new pain management provider. Make the time.
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