Pain Is Undertreated in Seniors, Experts Say

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

The following information is reproduced with the permission of
The National Council on the Aging.

---

Pain Is Undertreated in Seniors, Experts Say

-- Safer, more effective pain management could improve quality of life --

Safer, more effective therapy could improve the quality of life of older Americans who take pain medication. This conclusion was shared by pain specialists and experts on aging who reviewed findings of a survey released in June 1997 by The National Council on the Aging, Inc. (NCOA). The survey, conducted by Louis Harris & Associates on behalf of NCOA, examined how pain and its treatment affect the lives of the nearly one in five Americans over age 60 who regularly take pain medication for arthritis and other chronic pain conditions.

While the majority of those surveyed believe pain drugs are effective, two in three seniors who take them say pain still prevents them from doing routine tasks and hobbies. Activities most likely to be affected include walking, housekeeping, gardening, and socializing. "Not only does pain impair quality of life for many older people, but it can also limit their ability to function independently," said Donna Wagner, Ph.D., Vice President, Research and Demonstrations, NCOA.

A tendency among seniors to settle for even a small degree of pain relief may explain why most seniors say medication is effective even though pain still interferes with their lifestyle, according to Betty Ferrell, Ph.D., F.A.A.N., Associate Research Scientist, City of Hope National Medical Center in Los Angeles, CA. "For many, any level of pain relief is better than none at all." Dr. Ferrell noted that older Americans surveyed were more likely to take weaker non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, than more potent analgesics including propoxyphenes, codeine derivatives, and other opioids. "The wide use of NSAIDs reported in the survey reflects an overall pattern of undertreating pain in the elderly," she said.

Dr. Ferrell is also concerned about findings that show seniors typically take NSAIDs for long periods of time. "Older Americans typically take prescription NSAIDs for six months or more despite regulatory warnings that risk increases after just three months. Large numbers of seniors also take the lower-strength, non-prescription NSAIDs on average for five years. These types of NSAIDs are known to cause serious gastrointestinal side effects."

Other types of side effects caused by pain medications also pose particular risk to seniors. "Drowsiness and dizziness are common side effects of pain medications," said Dorothy Baker, Ph.D., Associate Research Scientist, Program on Aging, Yale University School of Medicine. "These increase the risk for falls and hip fractures, a leading reason for premature entry to nursing homes."

The increasing participation of older Americans in managed care plans may also play a role in less than optimal chronic pain management for seniors. "Older people are likely to see at least three different doctors for pain care, but the vast majority see primary care physicians. They only rarely see rheumatologists or other professionals who specialize in treating chronic pain," Dr. Wagner said. "Managed care plans may limit their access to these specialists."

Dr. Wagner believes that better communication with doctors is key to improved chronic pain management for seniors. "While most older Americans surveyed said their physician or pharmacist had talked to them about the side effects of pain drugs, only half said their physician or pharmacist had discussed possible drug interactions with other medications they take. Understanding potential drug interactions is critical for older people, because they typically take up to seven different medications a day. Seniors should make sure doctors and pharmacists are aware of all the medications they take, and contact doctors immediately if they notice side effects or other problems that might be related to their pain drug."

The Pain & Older Americans Survey is a survey of national cross-section of 500 randomly selected Americans over age 60 who regularly take pain medication that was prescribed or recommended by their doctor for pain conditions lasting six months or longer. It was underwritten by an educational grant from Ortho-McNeil Pharmaceutical.

Return to the IATROGENIC INJURY Page

Return to PAIN MANAGEMENT