Persistent Pain in the Elderly: Recognition and Treatment


Pain is an unpleasant sensory or emotional experience that can be associated with actual or potential injury. It can be categorized as chronic or persistent pain, which refers to pain lasting for more than three months. Generally, acute pain is expected to subside within three months, but when it continues beyond that timeframe into daily living, it is referred to as persistent or chronic pain.

Elderly Male

Defining the 'Elderly'

Individuals who are chronologically older than 65 are typically classified as older adults or commonly referred to as the elderly. However, it is important to note that age alone does not determine one's experience of aging. We often come across younger individuals who may feel disabled, experience pain, and appear older than their actual age. Conversely, there are individuals in their 80s or 90s who maintain excellent physical condition and vitality. Therefore, the perception of being elderly is not solely based on age, but rather how an individual feels and experiences their own aging process.

The Importance of Managing Chronic or Persistent Pain in the Elderly

The management of persistent pain in older adults holds significant importance due to the potential negative consequences it can bring. When left unaddressed, the impact of pain can contribute to social isolation, substantial limitations in mobility, changes in weight, mood alterations, and even the progression of dementia. Therefore, it is of utmost importance to prioritize effective pain management in older adults to enhance their overall well-being and quality of life.

Chronic Pain's Unique Impact on Elderly Patients

Pain perception varies among individuals, including elderly patients. Older adults often have different pain thresholds and sensations. In some cases, there may be a decrease in overall pain sensitivity, leading to a higher threshold for experiencing pain. However, it is also common for certain elderly people to exhibit heightened sensitivity to pain, perceiving it more acutely. This diversity in pain experiences is frequently observed within the elderly population.

Pain Underreporting in the Elderly

One of the main reasons for the underreporting of pain in older adults stems from a common misconception or myth that pain is an inevitable part of aging. However, this belief is often inaccurate. Many specific causes of pain can be identified and effectively treated or managed, leading to an improved quality of life for the elderly. It is crucial to challenge this misconception and encourage older adults to report their pain, as proper assessment and intervention can significantly alleviate their discomfort and enhance their overall well-being.

Recognizing Symptoms of Chronic/Persistent Pain in the Elderly

In older adults, the symptoms and signs of pain may manifest in various ways. While pain itself is a primary symptom, it is common for older adults to refrain from reporting it, assuming that experiencing pain is a normal part of their daily lives. However, it is crucial to encourage reporting. Additional symptoms that may indicate the presence of chronic or persistent pain in older adults include a decrease in overall physical function, changes in mood such as agitation, depression, or anxiety, and a decline in both physical and mental abilities. These collateral symptoms often accompany persistent pain in the elderly and should be taken into consideration during assessment and treatment.

Measurement and Considerations

The measurement and assessment of pain in older adults involve various options, depending on the individual's capabilities. One common approach is the use of a numeric scale, where patients are asked to rate their pain on a scale from zero to 10. Zero represents no pain, while 10 signifies the worst imaginable pain.

For older adults with cognitive impairment, alternative scales such as verbal analog scales are available. These scales often use facial expressions, and patients are asked to point to the face that corresponds to their current level of pain. A happy face represents no pain, while the presentation of the worst pain is depicted differently.

In addition to numerical and visual scales, it is important to ask further questions to gain a comprehensive understanding of the pain experience. For instance, patients may be asked how their pain has affected their physical performance, how many times they have had to forego favorite activities due to pain, and what other limitations they have experienced.

It is crucial to explore these questions because older adults may not proactively report their pain, believing that it is a natural part of aging. Similarly, physicians may hesitate to inquire about pain if patients do not bring it up themselves. However, the presence of pain is independent of perceptions or expectations. It is a real and limiting experience for patients, often causing them to suffer silently. By actively addressing pain and offering appropriate interventions, patients can potentially find relief and regain their happiness and well-being.

Understanding the Causes of Persistent Pain in the Elderly

Persistent pain in older adults is often attributed to various factors. One common cause is the presence of diseases, such as arthritis, both inflammatory and degenerative types. Additionally, injuries, including falls, can contribute to persistent pain. Certain medical treatments, such as chemotherapy for cancer or post-surgical effects, can also lead to ongoing pain. In fact, surgery itself is a common cause of persistent pain, with up to 40% of patients experiencing this outcome.

Furthermore, smoking has been associated with pain, particularly in the back and disc damage. The use of nicotine has been linked to an increased risk of pain in these areas. While these causes are frequently observed, there may be other contributing factors that can lead to persistent pain in older adults.

Risk Factors for Persistent Pain in the Elderly

Several risk factors are associated with the development of persistent pain in older adults. One risk factor is overuse, which occurs when individuals excessively strain their muscles without adequate recovery. It is important to be cautious about how we use our bodies as we age and to prioritize proper care and recovery.

Another significant risk factor is previous surgery or certain medical conditions. Surgical procedures can sometimes result in persistent pain even after the healing process. Additionally, falls can be a risk factor for pain, particularly when they lead to compression fractures or other related conditions.

While these are some common risk factors for persistent pain in the elderly, it is essential to consider each individual's unique circumstances and medical history to fully assess their risk factors for experiencing ongoing pain.

Treating Persistent Pain in the Elderly

Persistent pain in older adults can be addressed through various treatment options. One common approach is the use of medications; however, caution must be exercised with aging individuals as some medications can lead to increased problems or intolerance. Adjusting medication doses and selecting appropriate types of medications are important considerations.

In addition to medications, non-pharmacological treatments play a significant role in managing persistent pain. Physical rehabilitation, chiropractic care, acupuncture, and other alternative therapies are often utilized to provide relief. Non-traditional options such as nerve ablation or injections can be effective in certain cases and are routinely used to alleviate pain.

Surgery is considered a last resort but may be necessary when severe pain becomes intolerable and other treatment modalities have been exhausted. In such cases, surgery can be a viable and beneficial option. It is important to carefully evaluate the individual's condition and determine the most suitable treatment approach for their specific needs.

Pharmacological Treatment Options for Chronic Pain in the Elderly

The use of NSAIDs and analgesics for treating chronic pain in older adults depends on the patient's individual presentation. If the patient has normal kidney function and can tolerate non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Naproxen, Meloxicam, or similar medications, they may be recommended. However, routine use of these medications is not advised due to their potential negative effects on blood pressure, heart, and kidneys. It is crucial to exercise caution and consult a doctor about their appropriate usage.

There are other types of analgesic medications available as well. Opioid analgesics may be used if deemed appropriate for the patient's condition. Additionally, non-opioid analgesics, including medications for nerve pain or those aimed at improving pain perception, can be considered. Topical creams and other alternative options are also available for the management of persistent pain in patients. The selection of the most suitable pharmacological treatment of pain depends on the individual's specific needs and should be discussed with a healthcare professional.

Pain Medicine at Western Reserve Hospital — 100% Patient Centered Pain Treatment

At the Center for Pain Medicine at Western Reserve Hospital we provide the latest innovations in comprehensive pain treatment. When persistent and chronic pain sets in, your life shrinks to fit your pain. Your health, work, and relationships suffer. You become less active. Often, you cannot sleep or suffer from depression. Living with chronic pain is hard, and the anxiety, stress, and anger that accompany it can make the pain even worse. The pain specialists at the Center for Pain Medicine at Western Reserve Hospital can help you conquer your pain with sophisticated new treatments and compassionate, professional care. Contact us at (330) 971-7246​ to schedule an appointment and begin the journey to pain relief today.