Pain and the Elderly

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Pain and the Elderly
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Pain

• General Population Most common reason to seek
  medical attention
• Over 85 older adults have a chronic disease
  characterized by discomfort

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Incidence of Pain

• Arthritic pain is the most common cause of pain
• Chronic pain for the elderly is caused by
• Cancer
• Osteoporosis with comp fx
• DDD
• Diabetic neuropathy
• Post herpetic and trigeminal neuralgias
• Residual neurologic deficits

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Atypical Presentations of Pain

• Acute MIs occur without pain, appendicitis,
  gangrene of the bowel, peptic ulcer, pneumonia
  cause little pain.
• Elderly show observable behavior changes
• Confusion, fatigue.
• Cardinal signs of inflammation may be less
  obvious
• Elderly tend to complain less, pain is part of age

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Psychosocial Aspects of Chronic Pain

• Chronic pain has multiple components
• Strong relationship between chronic pain and
  depression and anxiety.
• Consider the recovery of a depressed vs. not
  depressed person
• Consider the social support networks of this
  population
• Most research indicates that age has no effect on
  depression with chronic pain

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Physiology of Pain

• In the absence of pathology, there is no age
  related differences in pain threshold or pain
  tolerance in laboratory induced pain.
• Unfortunately there are no longitudinal studies
  on actual acute and chronic pain of elders.
• Despite evidence of reduced endogenous opioids in
  this pop. TENS has been shown to be effective.
• Peripheral neuropathies are caused by ischemia to
  nerve cells secondary to blood vessel damage.(DM)

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Pain Measurement

• Verbal scale
• Visual Analog
• McGill
• Pain diary
• Facial Expression with Alzheimers

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Intervention Special considerations with the
Elderly

• MEDs
• Thermal modalities exercise great caution with
  impaired circulation and sensory deficits. I.E.
  DM, neurological disorders, communication
  disorders
• Use relaxation, visual imagery, massage
• Positioning or support to decrease stress
• Active movement
• Education

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Case Study

• 78 yo retired teacher comes to your OP PT clinic
  with c/c L sided neck and shoulder pain. 2/10
  rest., 5/10 activity., 8/10 upon waking. Pt
  reports shoveling snow 3 days ago as the cause of
  the trouble. PMH OA both knees, Arrhythmia.
• Examine and treat this patient