Pain  in  the  Elderly  Assoc.  Prof.  Brendan  Moore  

 University  of  Queensland  

Pain  Medicine  Specialist    Brisbane  Private  Hospital  and    Greenslopes  Private  Hospital  

Prevalence  of  Persistent  Pain  

•  Prevalence  is  17  %  for  males  and  20%  for      females  

•  Prevalence  increases  with  increasing  age  •  Peaks  at  27%  for  males  aged  65  –  69  yrs  •  Peaks  at  31%  for  females  aged  80  –  84yrs    

Blyth  FM  et  al  Pain  2001;89:127-­‐134  

Mul5ple  Causes  of  Pain  in  Elderly  

•  Ageing  does  not  cause  pain  •  MulRple  pathologies  increase  with  age,  

some  of  which  may  be  painful  •  May  have  mulRple  causes  of  pain  •  New  symptoms  require  proper  evaluaRon    

Mashford  et  al.  TherapeuRc  Guidelines:  Ed  4.  2002  

Does  Sensi5vity  to  Pain  change  with  age?  

Discussion  Point  

Pain  Sensi5vity    may  differ  with  Increasing  Age  •  Elderly  may  have  higher  thresholds  to  Pain  •  The  Elderly  may  experience  less  Pain  at  

lower  levels  of  sRmulaRon  •  But  once  felt  as  pain,  the  sensaRon  is  no  

different  from  younger  people    

Mashford  et  al.  TherapeuRc  Guidelines:  Ed  4.  2002    

Can  people  with  Demen5a  accurately  

report  Pain?  

Discussion  Point  

Demen5a  and  Repor5ng  of  Pain  •  Able  to  report  current  pain  •  Past  pain  reports  less  accurately  reported  •  As  demenRa  increases,  ability  to  report    

 pain  decreases  •  As  communicaRon  fails,  importance  of  

 observaRon  increases  

Mashford  et  al.  TherapeuRc  Guidelines:  Ed  4.  2002  McClean  WJ.  Nursing  &  ResidenRal  Care  2003:5(9)  428-­‐430  

Influence  of  Cogni5on  

People  with  demenRa  are  more  likely  to  have    pain  that  is  not  treated  

ContribuRng  factors:  •  Less  likely  to  volunteer  informaRon  •  Less  likely  to  complain  about  pain    

McClean  WJ.  Nursing  &  ResidenRal  Care  2003:5(9)  428-­‐430  

Degenera5ve    Lumbar  Back  Pain  

Assessing  Back  Pain  

•  Is  the  pain  mechanical?  •  Are  there  neurological  features?  •  Is  there  correlaRng  leg  pain?  •  Are  further  invesRgaRons  required?  

Pharmacological    Treatment  of  Pain  

In  the  Elderly  

Special  Considera5ons    in  the  Elderly  

•  MulRple  sources  of  Pain  •  ComorbidiRes  and  polypharmacy  •  Reduced  effecRve  renal  funcRon  •  Reduced  muscle  mass,  increased  adipose  •  Increased  drug  sensiRvity  

Mashford  et  al.  TherapeuRc  Guidelines:  Ed  4.  2002  NaRonal  Prescribing  Service.  Drug  use  in  the  elderly.  PPR26  July  2004  

Opioids  

Opioid  Trial  Guidelines  •  Use  low  dose,  sustained  release  opioid  Start  Low  and  Go  Slow  

   for  paRents  who  are:  •  Elderly  •  Taking  other  CNS  depressants  •  Opioid  naïve  •  Have  hepaRc  or  renal  insufficiency  

Opioid  Dose  Equivalence  

MAXIMUM  Opioid  Dose  Guide  

Principles  of  Good    Prescribing  in  the  Elderly  •  Prescribe  lowest  effecRve  dose  •  Small  number  of  medicaRons  •  Simple  dose  regime  •  Simple  verbal  and  wrihen  instrucRons  

NaRonal  Prescribing  Service.  Drug  use  in  the  elderly.  PPR26  July  2004  

“Pain  is  not  a  normal  part  of  aging  

and  should  be  evaluated  as  in  any  other  age  group”  

Pain  the  Fi/h  Vital  Sign  

American  Pain  Society  Mashford  et  al.  TherapeuRc  Guidelines:  Ed  4.  2002    

Thank you