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Getting Old Doesn't Have to Hurt

American Geriatrics Society releases new pain management guidelines

WEDNEDSDAY, May 22, 2002 (HealthDayNews) -- Aches and pains are an inevitable part of getting older, right?

Not so, say recently published guidelines on managing persistent pain from the American Geriatrics Society.

"Pain is not a normal part of aging," Dr. Paul Katz, a geriatric specialist from the University of Rochester, explained at the society's recent annual scientific meeting in Washington, D.C. "It is eminently treatable."

The guidelines were first developed in 1998 to help ensure that older people received effective pain management that would let them maintain their dignity and overall quality of life.

More than 75 million Americans -- that's one in four -- live with chronic pain. Pain costs the United States $70 billion every year in medical and lost productivity costs, according to the National Pain Foundation.

The need for the guidelines came about because concern about causing addiction to pain medication sometimes leads doctors to treat pain less aggressively, and many patients are unaware there are effective treatments available, reports the foundation.

"Everyone was afraid to treat older people because of the concern that older people were getting too much medication, like Valium and other tranquilizers," says Dr. Michael Freedman, director of the division of geriatrics at New York University Medical Center. "So, then everybody stopped treating pain, and patients were left in terrible pain."

However, he adds, there are many new pain medications and some have fewer side effects. Also, he says, physicians have learned they can give elderly patients narcotics for their pain without causing addiction.

The guidelines were updated this year to include the newer medications and more recent evidence from medical studies.

Some of the most important guidelines include:

  • All older patients should be asked if they are in pain. If they have pain, doctors need to take the time to accurately assess the pain.
  • For people who are cognitively impaired, like Alzheimer's patients, doctors should interview their caregivers about any possible pain the patient might be feeling.
  • Treatment should be as simple as possible.
  • Placebos should never be given to patients.
  • Acetaminophen should generally be the first drug tried for pain.
  • Over-the-counter, non-steroidal anti-inflammatories such as Advil and Motrin should be avoided for people who need long-term therapy, in favor of prescription anti-inflammatory medications, such as Celebrex and Vioxx, which appear to have fewer adverse side effects.
  • Patient and caregiver education in pain management is essential.
  • Exercise should be encouraged to increase flexibility and strength.

"When a patient comes in with pain, the most important thing to do is relieve the pain," Freedman says. "Pain is terrible. Think about when you get a headache, you can't do anything."

What To Do: For more information on pain management for older people, visit the Foundation for Health in Aging, or go here to download a pain diary to keep track of your symptoms.

SOURCES: Michael Freedman, M.D., professor, geriatric medicine, New York University School of Medicine, and director, division of geriatrics, New York University Medical Center, New York City; May 9, 2002, Web cast, annual scientic meeting, American Geriatric Society, Washington D.C.
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