Improved management of chronic pain can significantly reduce disability in older adults, according to the latest issue of the What's Hot newsletter from The Gerontological Society of America.

Pain in aging adults has historically been poorly reported, recognized and managed. There has been a lack of identifying pain as a real problem in the elderly, particularly in longterm care facilities and patients with Alzheimer's or other dementias.

We know how pain can affect us in our daily activities: A terrible headache, or backache will limit our activity, decrease our concentration, and affect our mood. We can take an over the counter or prescription medication, use heat or ice, and reduce or resolve the pain, and go on with our day.

Imagine if you had no control over your medications. Imagine you are unable to tell the nurse in the facility you live in that you have an excrutiating headache, or your hands hurt so bad from arthritis that you can't even pick up a fork to eat. Millions of seniors live like this on a daily basis.

For those who can report pain to family members, physicians and nurses in long term care facilities, there is an under-reporting of pain, particularly in the male population.

Men carry the burden of gender expectations. Men are supposed to be tough. Enduring pain without talking about it is a part of how many men were raised. "Grin and bear it" type attitude.

Practitioners in health care are improving in their recognition and assessment of pain, but we are a still a long way off from adequate pain management in the elderly population, especially in those who can't or won't report pain.

The move to offering senior emergency rooms, like those at St. Joseph Mercy Ann Arbor and Saline, are much more likely to accurately assess and treat pain in the aging population than general population emergency rooms, so things are improving.

Pain has been talked about as the sixth sense. Pain should be a part of every assessment by a nurse or physician. Families also need to recognize pain as a possible issue when family members are providing care for a spouse or parent.

Pain is either acute or chronic, meaining it's either for a brief period of time, and can usually be related to a cause, or it's long lasting and may or may not have a causative factor.

Pain management can be very different for acute versus chronic pain. If someone has been diagnosed with an illness or disease with a symptom of pain, such is in arthritis, fibromyalgia or spinal disk disease or injury, it can be much easier to monitor, recognize and treat pain, because it's expected. Pain unrelated to a previous diagnosis is less likely to be identified.

Understand that pain of any type is not normal, and pain intensity varies from person to person. Whatever pain we have, we relate to previous incidences of pain in our lives. What is mild or intense for one person may be entirely different for another.

For instance, if a healthy woman has experienced nothing more than an occasional headache, stomachache or bruise, she will compare future pain based on her mildest and most severe pain. Most of us wouldn't consider any of those types of pain severe, but for her, a bad headache can be felt as excrutiating.

Another woman who has experienced those same pains but has had a baby, and say, a knee replacement, would say her worst was having a baby or the knee replacement and would compare all future pain to those pain experiences. There are also biological contributors which factor into our perception of pain, but for our purposes I won't go into that.

For those reasons alone, no one but the person experiencing the pain should be a judge of our pain perception and how it affects our lives.

Giving pain a number is the best describing factor. If we use 0 as no pain, and 10 as the worst ever, we can easily report the intensity to a nurse, physician or family member. We also need to keep the numbered pain scale in mind after we take any medications or use other methods to reduce pain, such as an ice pack or heat.

The only way to manage pain is to assess the effectiveness of the treatment. If your pain was at a 7 prior to a medication, and an hour after the medication it was a 2, the treatment has been pretty effective. If the pain remained the same or only went down to a 5 or 6, the treatment wouldn't be that effective.

Pain management doesn't necessarily mean a patient will no longer experience the pain after being treated, because for some people and certain types of pain, that is not reasonable. Reducing the pain to a tolerable level that allows us to function as well as possible may be considered excellent pain management.

There are physical indicators of pain in persons who cannot communicate pain and ways to recognize pain are facial grimacing or moaning and yelling out, particularly with movement.

Guarding the painful area, such as not using an arm that is hurting or limping, are examples of nonverbal pain indicators. Decreased mobility, decreased appetite, mood changes and changes in blood pressure and/or pulse can all indicate pain.

What is more difficult is to understand the type and intensity of the pain. Doctors and nurses want to know types of pain, such as burning, aching or throbbing. Persons unable to communicate the type have to be thoroughly assessed to find the cause.

Grimacing, or moaning and yelling out can be an indication of intensity but may not be in persons with dementia. Those actions could relate to other thoughts or activities a person finds displeasing.

Untreated pain in the elderly can result in depression, decreased activity or decreased food and fluid intake. It can cause pain in other areas from guarding arms, legs or back, putting pressure on other areas of the body.

Untreated pain in persons with dementia can be expressed in behavorial problems that are inaccurately treated or sleep problems. Untreated pain causes a variety of additional problems, and that is one reason it's so important to recognize, assess, and accurately treat pain.

We don't want to see an Alzheimer's patient put on antipsychotic, antianxiety or sleeping pills because they have uncontrolled pain. Many elderly individuals have been misdiagnosed and treated improperly because of undiagnosed and untreated pain.

Here are 7 important considerations to remember:

1. We all have to keep in mind that pain in any form is not normal.


2. We all experience pain differently.


3. We do not and should not just endure pain without treatment.


4. Person with dementia, and others unable to communicate, will and do experience pain. Monitoring for pain on a daily basis is extremely important and should be one of the first considerations if there are noteable changes in functioning and demeanor.


5. We must advocate for ourselves and family members for pain assessments and adequate pain control. If your health care provider doesn't take pain your seriously, seek another provider who will.


6. Always monitor and report the effectiveness of a natural or prescribed treatment. If it is ineffective advocate for an alternative treatment that is effective.


7. Some pain medications can cause elderly patients to fall, or have hallucinations, so if there are any adverse side effects notify the physician immediately so an alternative medication can be ordered.