Pain and the Elderly

By arhospice on September 12th, 2022

As our bodies age, most of us will experience pain of varying degrees. Statistics show that 2 in 3 seniors say that pain keeps them from performing their routine daily activities. Plus, 4 in 5 seniors take medications regularly for chronic pain. Oftentimes, dealing with pain leads patients to need assistance from a caregiver, such as a family member or friend.

Pain is difficult to define because the sensation is different for each individual, but, in general, pain is:

  • A sensation that hurts – causing discomfort, distress, or even agony.
  • An uncomfortable feeling that tells you something may be wrong in your body.

There are two main types of pain: acute pain and chronic pain. Pain is considered acute when it is temporary, lasting for a few hours or, at most, up to six months. Pain is considered chronic when it is long term – lasting for six months or more.

Pain is not:

  • A normal part of getting older.
  • Necessary to “build character.”
  • Something that can’t be measured with a blood text or an x-ray.
  • All in people’s heads.
  • Always well-managed for people over age 65.

Complications regarding pain

When pain is not well-managed, complications can develop, including:

  • Immobility, which puts elderly people at risk for pressure sores, constipation and pneumonia.
  • Depression, which may cause seniors to feel hopeless and overwhelmed.
  • Lack of interest in eating or drinking, which can quickly lead to dehydration and malnutrition.
  • Disturbed sleep patterns, which can cause fatigue and an inability to function during the day.
  • Physical and emotional suffering.

Sometimes, seniors may have attitudes, beliefs or cognitive challenges that become obstacles to managing their pain. Seniors may:

  • Be reluctant to report their pain if they see it as a sign of weakness.
  • Have been suffering with pain for so long that they have given up.
  • Feel that no one takes their pain seriously, so they don’t bother talking about it.
  • Fear that the side effects of pain medications may be worse than the pain itself.
  • Be afraid that taking pain medications will make them an addict – or so “doped up” that they will have no quality of life.
  • Believe that complaining about pain makes them a burden to their caregivers and families.
  • Think that pain is “normal” for their age.
  • Suffer from dementia, confusion or memory loss.

Suggestions for caregivers

Dealing with pain can be stressful both for the patient and the family caregiver. Here are some suggestions that might help:

  • Communication
    • Don’t assume that the patient is pain-free just because they don’t seem to be hurting.
    • Be sure to ask your patient regularly if they are comfortable – because the only way to really know if someone is in pain is to ask.
    • Listen for words that might indicate pain.
    • If patients tell you they are in pain, believe them. Often, when elderly people feel that others doubt their pain, they stop talking about it. This can keep their pain from being properly treated.
  • Triggers
    • Keep an eye out for specific events that trigger pain, including:
    • The weather, such as high humidity or a storm brewing.
    • Hot or cold temperatures.
    • Too much or too little activity.
    • Staying in one position too long.
    • Performing a repetitive motion.
    • Eating certain foods.
    • If you identify a “pain trigger,” be sure to let your patient’s medical provider know.
  • Relaxation
    • Remember that pain and stiffness may be worse when seniors first wake up in the morning. If so, ask them what you can do to make them more comfortable – and allow them plenty of time to get their muscles and joints moving before breakfast.
    • Encourage patients to relax. Remind them that breathing slowly and thinking peaceful thoughts might help reduce pain.
    • Pamper your patients when they are in pain. Apply some lotion, take a little extra time with their hair, or give a gentle foot rub.
  • Medications
    • Help your patients be compliant with their pain management plan. This may involve watching them take their medications, helping them with prescribed exercises, providing them with nourishing foods, and/or reminding them to use assistive devices.
    • Try to prevent complications form pain medications. For example, constipation is a common side effect of narcotic pain medicines, especially among the elderly. To prevent it, encourage patients to drink plenty of water, to eat high fiber foods like fresh fruits and vegetables, and to get some daily exercise.
  • Attitude
    • Give your loved one a reason to laugh. Sometimes, just a few minutes of laughter can lead to an hour of pain relief.
    • Remember that working with the elderly takes plenty of patience – especially when they are in pain.

Recognizing and discussing pain

As a caregiver, you play an important role in helping the medical team understand your loved one’s level of pain.

Below are signs to watch for in patients with dementia or that are nonverbal who might be experiencing pain:

  • Repetitive movements, such as rapid blinking or rocking.
  • Repetitive words or phrases like “Help!” “Get away!” or “Don’t touch me!”
  • Physical signs of pain, such as restlessness, rubbing a body part or closing the eyes tightly.
  • Changes in behavior, such as a loud person suddenly becoming quiet, a quiet person suddenly crying, or someone who suddenly stops eating or sleeping.
  • Moaning, groaning, repeated calling out
  • Facial grimacing
  • Body curled in fetal position, tense, clenched fist(s)
  • Striking out
  • Labored breathing

Reporting pain

You play an important role in helping your loved ones’ medical team aware of pain. Let them know if patients:

  • Complain that their pain is not relieved after taking pain medication.
  • Describe a new type of pain or pain in a new location.
  • Show non-verbal signs of being in pain, such as restlessness, rubbing or holding a body part, crying, rocking or moaning.
  • Walk or move differently because of pain.
  • Suffer from nausea or vomiting, constipation or any other side effects of pain medication.
  • Talk about not wanting to live anymore. (People who suffer from chronic pain can become so depressed that they feel suicidal.)
  • Stop eating or drinking.
  • Complain about being unable to sleep.

4 Pains that should never be taken lightly

While pain should never be ignored, there are 4 types of pain that need prompt medical attention:

  • Intense headache: While headaches have many causes, seniors who complain of a serious headache may be experiencing a brain disorder such as a stroke or an aneurysm.
  • Chest pain: Elderly people are at risk for heart disease and pneumonia, both of which can cause chest pain. If the pain is cardiac in nature, it may radiate to the throat, the jaw, the left arm or the abdomen.
  • Severe abdominal pain: Elderly people who take narcotics for pain are at risk of developing constipation. If the problem is severe, it can lead to impacted stool and/or a bowel obstruction.
  • Burning feet or legs: As people age, their risk of developing type 2 diabetes increases. Nearly one-third of people with diabetes don’t know they have the disease. For some people, neuropathic pain, such as burning in the feet or legs, is the first sign of diabetes.

Using medications to treat pain

There is a general understanding among people who work with the elderly that, as people age, they become less alike. For example, physicians know that most 30-year-olds respond to specific pain medications in a similar fashion. But, if a doctor gives that same medication to 5 seniors, there will likely be 5 different reactions.

For this reason, physicians follow a basic “rule” when they prescribe pain medication to elderly patients. They “start low” (with the minimum dose of the medication) and they “go slow” (increasing the drug in small increments, if necessary).

There are a variety of types of medication used to treat pain. Talk with your loved ones’ doctor about the best type for your loved one’s condition.

Also, be mindful that older people run a higher-than-average risk of developing side effects from pain medications. The average senior takes at least 4 different medications every day. Adding pain medications to the mix boosts the chance of a negative interaction between medications.

While strong pain medicines can cause confusion, being in uncontrolled pain can also cause seniors to become confused. If you notice that your patient is newly confused, be as specific as possible when reporting your observations to your physician or medical team.

Out of desperation, elderly people may turn to unproven remedies to relieve the pain. They may see something advertised on television, in magazines, or on the Internet. Using a “quack” remedy may not do any harm, but it won’t manage anyone’s pain. If you notice an elderly patient showing interest in a product that might be a “quack” cure, let your physician know. It might mean that his or her pain has been undertreated.

Terms regarding pain that you might need to know

When healthcare workers talk about pain, they frequently use special words and phrases. Some of those are below.

  • Pain management is the process of providing medical care to ease or reduce someone’s pain.
  • Pain tolerance is the maximum amount of pain a person is willing to tolerate. Pain tolerance can vary for the same person at different times and in different situations. It can be influenced by how people were raised and by their cultural and family traditions. A high or low pain tolerance can also be hereditary.
  • The pain threshold is the point at which a person becomes aware of pain. People with a high pain threshold don’t seem to feel pain as quickly as people with a low pain threshold. A person’s pain threshold can be affected by many factors, including nausea, fatigue, anxiety, lack of sleep, the time of day, or a previous experience with pain.
  • Persistent pain is pain that lasts for 12 hours or longer every day.
  • Radiating pain is pain that begins at the source and extends to nearby tissues. For example, a sprained ankle can cause a whole leg to ache.
  • Referred pain is pain caused by one part of the body but felt in a different part. For example, people who have arthritis in their hip may only feel pain in their knee. Or, someone with an inflamed gall bladder may only hurt in their right shoulder.
  • Breakthrough pain is a sudden “flare up” of intense pain that happens even though a person is being treated for pain.
  • Movement-related pain is a type of breakthrough pain related to a specific activity, such as eating, toileting, socializing or walking.
  • Transient pain is a brief discomfort from the minor bumps, nicks, and scrapes experienced in everyday living. Normally, people don’t seek (or need) medical attention for transient pain.
  • The wind-up phenomenon is the idea that untreated pain gets worse because nerves get better at sending pain messages after “practice.” This is one explanation for why untreated pain gets worse. The more often that nerve fibers need to send pain messages to the brain, the better they get at it. The nerves get “wound up” like a spring, ready to send pain signals at any moment. And, the brain learns to become more sensitive to these pain messages. So, the person suffers from even more pain – even though the injury or illness has not gotten any worse.

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