The problem of pain in old age

Non-Public Health Care Institution ‘DAR’, Jarosław, Poland; Health Care Institute, State School of Higher Vocational and Economic Education, Jarosław, Poland
Neurology Department, Medical Care Centre in Jarosław, Poland
Department of Clinical Endoscopy, Institute of Rural Health, Lublin, Poland
Ann Agric Environ Med 2013;20(1):35–38
The elderly are more susceptible to feeling pain than young people. Pain is described as a complex, subjective feeling causing significant limitation of physical, psychical and social functioning. In the literature, there are many classifications of pain. Considering the duration, pain may be divided into acute and chronic. Acute pain does not depend on age and lasts less than three months whereas chronic pain is more frequent with the elderly and lasts more than three months. It can be divided into nociceptive and neuropathic pain. Involutional changes progressing in the organism of an old person, combined with numerous chronic diseases occurring in old age, cause approx. 85% of the elderly to suffer from pain. Among the diseases with concurring pain, the first are diseases of the locomotor system and include: osteoporosis, osteoarthritis, and rheumatoid arthritis. Moreover, pain is an intrinsic part of malignant cancer, neuralgia shingles, and diabetic neuropathy. Pain also conceals depression and the depression intensifies the feeling of pain. Due to frequent cognitive disorders and depression, the measurement of pain in the elderly is difficult, it thus requires vast experience. To assess the pain intensity, subjective scales are used, e.g. verbal scale, score scale. To assess the qualitative and quantitative scales the following questionnaires are used: McGill-Melzak Pain Questionnaire and the Pain Assessment Form. Significant for pain assessment with people diagnosed with dementia are objective pain symptoms, namely: worsening appetite, gnashing teeth, grimaces. Pain treatment should be multimodal and include usage of both pharmacological and non-pharmacological methods. Pharmacology is the basis for pain treatment in people of old age, which should be used in the least invasive way, starting with small dosages. The pain-relieving medicine of first choice is paracetamol. In the pharmacological treatment of old people there are also non-opioid pain relieving medicine, opioids and supportive medicine. Among non-pharmacological treatments are rehabilitation and psychological therapy. In pain treatment, awareness among the elderly, their families and carers, and edical staff that the pain is not an attribute of old age; thus, it can be correctly diagnosed and treated.