Managing Pain in the Elderly

How can I help my aging father deal with his physical pain and discomfort? I'm his primary caregiver. He's never been very communicative, and I have reasons for believing that he's hurting a great deal more than he lets on. I'd like to help him manage that pain, but he's not very cooperative when it comes to admitting weakness or taking medications. Any suggestions?

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The fact of the matter is that many elderly adults are at risk of being under-treated for pain. There are a number of reasons for this. Your father might simply be reluctant to complain. He may assume that pain is a normal part of aging. He may even doubt that his pain is real or that it is severe enough to require treatment.

You need to be aware that this can become a serious situation. In some cases uncontrolled pain can be devastating. Even if it is not particularly severe, it can still significantly impair a person’s level of functioning and quality of life. Sometimes confusion, agitation, or what appears to be dementia can actually be caused by uncontrolled pain. Since you know your dad better than anyone else does, you’re in the best position to determine whether any of these scenarios are descriptive of his symptoms and to help him get the help he may need.

The most effective way to deal with this issue is to arrange a joint conference with your father’s physician (in order for the physician to speak with you about your father’s medical records your father must give his permission or you have must have power of attorney for health care decisions). You can prepare for this meeting by giving yourself a basic education in the essentials of pain and pain management.

To begin with, it’s helpful to understand that your father may be experiencing one of two kinds of pain: acute or chronic. Acute pain can be severe and may only last for a short period of time. It is typically the result of an injury, surgery, or illness, and it usually goes away on its own during the healing process. Chronic pain, on the other hand, continues for a longer period of time. It may be mild to severe. Arthritis and musculoskeletal disorders are two of the most common causes of chronic pain in elderly patients. Treatment options may be different for acute and chronic pain. It is often easy to discern that a person is experiencing acute pain by the distress that is evident on his face or by the level of agitation he shows. Chronic pain, on the other hand, is easily confused with sadness or fatigue as the only evidence may be knitted brows or a decreased physical or emotional energy level. Asking the person if he “has any pain” may also not yield a correct answer. Often exploring the situation using terms such as “discomfort” or “tenderness” and asking how well the person is sleeping are more reliable ways of determining if pain might be a problem.

In administering pain control, physicians can choose from two basic models of long-term use of pain medications. The scheduled or continual model involves short-acting medications given at regular intervals – on schedule – to prevent exacerbation of pain. A variation on this model is to give long-acting pain medications for chronic pain. Both approaches provide an ongoing analgesic effect.

The second model is the ” p.r.n.” technique (” p.r.n.” stands for pro re nata, or “as needed”). This technique uses short-acting medication on an as-needed basis for acute pain. The most appropriate use of the p.r.n. technique is in situations where a person who is already on regularly scheduled medications needs an additional dose to treat breakthrough pain. This approach is also useful when an immobilized elder needs to be repositioned or have a wound dressing changed. It should seldom be used as the main method of pain control for treatment of chronic pain.

When discussing pain control with your father’s physician, describe your father’s pain (or the pain you think he has) and ask the doctor how he would address it. Get details about the possible side effects of the medications he plans to prescribe. Be sure to inform him of any other medicines, including herbal remedies and nutritional supplements or vitamins that your dad may already be taking. You might also want to discuss the possibility of using a “pain-scale,” an evaluation tool that utilizes a five- or ten-point scale – usually a ruler with markings between zero and five or ten, with zero representing “no pain” and five or ten representing “the worst pain imaginable.” Using this scale, you can help your father to rate his pain several times a day, thus providing the doctor with an objective measure by which to assess the pain and determine appropriate treatment.

For additional help and information on this topic, we’d encourage you to consult the resources and referrals highlighted below. Or if you have relationship concerns and challenges associated with this situation, please don’t hesitate to give our Counseling department a call.


Resources

Caring for Your Aging Loved Ones

Complete Guide to Caring for Aging Loved Ones

Coping with Chronic Illness

Referrals
National Association of Area Agencies on Aging

Caregiver Action Network


Articles

Caring for Ill or Aging Parents

Living With Chronic Pain and Illness

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