Chronic pain in elderly people

Medication adherence and health-related quality of life among people with diabetes in Bangladesh: A cross-sectional study

INTRODUCTION

Good adherence to anti-diabetic medications is an important protective factor for decreasing diabetes-related complications and disabilities but its association with health-related quality of life (HRQoL) is understudied. The current study aimed to assess an association between medication adherence to anti-diabetic drugs and HRQoL among people with diabetes in Dhaka city, Bangladesh.

METHODS

We conducted a cross-sectional study among 480 people with diabetes aged between 50 and 70 years, who attended a tertiary-level hospital in Dhaka city. We used the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L) to measure HRQoL and Morisky Medication Adherence Scale to assess the level of medication adherence to anti-diabetic drugs. Multivariable logistic regression was performed to assess the significance of relevant factors.

RESULTS

The mean age of the participants was 59.0 (standard deviation [SD], 7.0) years. The majority of the participants (74%) had a lower level of medication adherence. The mean value of (EQ-5D-5L) was 2.0 (SD, 1.0). The percentage of severe disability in different domains were 6.7% for mobility, 3.5% for self-care, 11.9% for usual daily activities, 11.9% for pain/discomfort and 11.3% for anxiety. After adjusting for age, sex, years of education, household expenditure, hypertension, duration of diabetes, glycemic status and multi-morbidities; low adherence to anti-diabetic medication was inversely associated with pain (OR, 0.26; 95% CI, 0.08-0.80; p = .036), and positively associated with anxiety (OR, 7.18; 95% CI, 1.03-9.59; p = .043).

CONCLUSIONS

Low medication adherence to anti-diabetic drugs was associated with anxiety and pain among the EQ-5D-5L indexes measured in people with diabetes in Dhaka, Bangladesh.

Management of post-traumatic stress disorder symptoms by yoga: an overview

BACKGROUND

Posttraumatic stress disorder (PTSD) can occur after trauma. While PTSD management strategies include first-line pharmacotherapy and psychotherapy, mind-body therapies, such as yoga, are applied in the PTSD population. This overview aimed to summarize the effectiveness of yoga interventions on PTSD symptoms in adults in a systematic review (SR) including randomized controlled trials (RCTs).

METHOD

We searched for SR with or without meta-analysis of RCTs involving adults with PTSD diagnosis or trauma history. The search was conducted until April 2022, through six databases (Cochrane Database, MEDLINE (Pubmed), Scopus, Embase, CINHAL and PEDro). The primary outcome was the evolution of PTSD symptoms throughout the intervention. Secondary outcomes included follow-up, safety, adherence, and cost of the intervention. Two authors independently performed the selection, data extraction and risk of bias assessment with the AMSTAR 2 tool and overlap calculation. This overview is a qualitative summary of the results obtained in the selected studies.

RESULTS

Eleven SRs were analyzed, of which 8 included meta-analyses. The overlap between studies was considered very high (corrected covered area of 21%). Fifty-nine RCTs involving 4434 participants were included. Yoga had a significant small-to-moderate effect-size on PTSD symptom decrease in 7 SRs and non-significant effects in 1 SR with meta-analysis. All SR without meta-analysis found beneficial effects of yoga on PTSD. Secondary outcomes were not sufficiently assessed to provide clear evidence. Results should be interpreted with caution as 1 SR was rated as at moderate risk of bias, 3 as low and 7 as critically low.

CONCLUSIONS

While yoga therapy seems promising for decreasing PTSD symptoms, future research should standardize yoga therapy duration/frequency/type and consider long-term efficacy to better delineate yoga therapy efficacy in PTSD patients.

Nocturnal pain, is the pain different compared with pain during the day? An exploratory cross-sectional study in patients with hip and knee osteoarthritis

OBJECTIVE

To explore characteristics of nocturnal pain and to identify differences in participants' characteristics and osteoarthritis (OA) symptoms between hip and knee OA participants with and without nocturnal pain.

METHODS

Data for this exploratory cross-sectional study were obtained from an online survey, distributed through social media and patient associations in the period from April 2020 until May 2020, which was conducted in 101 participants with (self-reported) hip or knee OA. Descriptive statistics were used to provide insight into the characteristics of the study population. Pain intensity, localization, dimension, and impact of (nocturnal) pain on sleep were described and compared with daytime pain.

RESULTS

Nocturnal pain was reported by 76/101 (75%) participants. Participants with nocturnal pain scored higher visual analogue scale (VAS) scores for their nocturnal pain compared with their pain at the moment (respectively: median VAS score 49.5 vs. 40.0). Their day pain rating indexes of sensory-discriminative dimension were higher compared with their nocturnal pain. Comparison between participants with and without nocturnal pain showed that participants with nocturnal pain were affected by intermittent, constant, and radiating pain. Pain had more impact on their sleep and they scored their pain at its worst higher compared with participants without nocturnal pain.

CONCLUSION

In participants with nocturnal pain (75%), we found that their VAS pain scores were not in harmony with their pain expressed in words. This study increases awareness of nocturnal pain in OA patients in general practice. More research is needed to provide general practitioners possible interventions for patients with OA and nocturnal pain.

Comparison of Older and Younger Patients Referred to a Non-interventional Community Pain Clinic in the Greater Toronto Area (GTA)

AIM

To compare demographic and pain characteristics of older (≥ 65) vs younger (< 65) chronic non-cancer pain patients referred to a community pain clinic in the Greater Toronto Area (GTA), Ontario, Canada.

METHODS

This is a retrospective study of 644 consecutive new patients with pain seen during 2016-2017 (older group n = 126; younger group n = 518). Demographic characteristics, Brief Pain Inventory pain ratings, and diagnosis were obtained using retrospective chart review. Patients were classified into group I (pure biomedical pathology), group II (mixed biomedical causes and psychological factors) and group III (no detectable physical pathology but psychological factors were considered important).

RESULTS

Older patients comprised 19.6% of the overall population (higher than the average GTA older population). Regarding older vs younger group, male/female ratio was 1:1.3 vs 1:1.7 respectively, while 71% of the older patients were foreign born vs 37% of the younger group (p < 0.001). Low back was the most prevalent pain site for both groups; 70% of the older patients were classified as group I vs 35% of the younger patients (p < 0.0001), and only 6% as group III (vs 18% of the younger population, p < 0.05).

CONCLUSION

The study points to considerable differences between younger and older patients with pain with the latter presenting with significant biomedical pathology but lesser psychopathology. The results are comparable to those obtained from a university pain clinic as well as a rural Northern Ontario clinic. Implications of the study for planning of pain care are discussed.

How Hospital Patients Experience Pain the Previous 24 Hours-A Prevalence Assessment of Pain in Five Hospitals in Sweden

BACKGROUND

Previous studies show that pain is common among hospital inpatients.

AIM

This study measures the prevalence of pain and the impact of pain on sleep in patients admitted to five hospitals in Sweden.

METHODS

The patients were admitted to a surgical or a medical ward. They answered on a self-reported questionnaire about their average pain intensity and how much their pain interfered with their sleep the previous 24 hours, on a 010 numerical rating scale (NRS).

RESULTS

Of the 500 patients, 308 experienced pain (62%), (NRS ≥ 3) and 111 (22%) rated their pain as NRS ≥ 7. We found no difference between surgical and medical specialty regarding pain prevalence. The results suggest that roughly the same proportion of patients with pain also experienced poor sleep due to pain265 patients (53%) reported pain interference on sleep, NRS ≥ 3.

CONCLUSIONS AND CLINICAL IMPLICATIONS

This study shows that there is still an unacceptable high pain prevalence in inpatients and that patients experience pain as negatively impacting their sleep. Future pain care is likely to include a more comprehensive implementation strategy for the dissemination of knowledge, especially related to the complex context of today's healthcare system. That is, the possibility that anchoring new knowledge also benefits the patient is probably associated with optimization of the structural context. Future research should take this question further by examining how the organizational structure should be optimized for the dissemination of knowledge in healthcare professionals about pain and pain interference with sleep.

Essential Oils, Phytoncides, Aromachology, and Aromatherapy—A Review

Chemical compounds from plants have been used as a medicinal source for various diseases. Aromachology is a unique field that studies the olfactory effects after inhaling aromatic compounds. Aromatherapy is a complementary treatment methodology involving the use of essential oils containing phytoncides and other volatile organic compounds for various physical and mental illnesses. Phytoncides possess an inherent medicinal property. Their health benefits range from treating stress, immunosuppression, blood pressure, respiratory diseases, anxiety, and pain to anti-microbial, anti-larvicidal, anti-septic, anti-cancer effects, etc. Recent advancements in aromatherapy include forest bathing or forest therapy. The inhalation of phytoncide-rich forest air has been proven to reduce stress-induced immunosuppression, normalize immune function and neuroendocrine hormone levels, and, thus, restore physiological and psychological health. The intricate mechanisms related to how aroma converts into olfactory signals and how the olfactory signals relieve physical and mental illness still pose enormous questions and are the subject of ongoing research. Aromatherapy using the aroma of essential oils/phytoncides could be more innovative and attractive to patients. Moreover, with fewer side effects, this field might be recognized as a new field of complementary medicine in alleviating some forms of physical and mental distress. Essential oils are important assets in aromatherapy, cosmetics, and food preservatives. The use of essential oils as an aromatherapeutic agent is widespread. Detailed reports on the effects of EOs in aromatherapy and their pharmacological effects are required to uncover its complete biological mechanism. This review is about the evolution of research related to phytoncides containing EOs in treating various ailments and provides comprehensive details from complementary medicine.

Effects of transcranial direct current stimulation on physical and mental health in older adults with chronic musculoskeletal pain: a randomized controlled trial

PURPOSE

We investigated the effects of transcranial direct current stimulation (tDCS) combined with physical therapy (PT) on pain levels, physical activity levels, quality of life, and depression in older adults with chronic musculoskeletal pain.

METHODS

Twenty-five older adults (9 males and 16 females), aged between 66 and 86 years (active group 77.2 ± 3.9; sham group 76.6 ± 6.2), volunteers were randomly allocated in the active (active tDCS + PT) and sham groups (sham tDCS + PT), and received the intervention three times per week for 8 weeks. Pain level, physical activity level, depression state, and quality of life were assessed based on the Visual Analog Scale (VAS), Physical Activity Scale for the Elderly (PASE), Beck Depression Inventory (BDI) scale, and Short-Form 36 Health Survey Questionnaire (SF-36), respectively. Measurements were conducted four times: at baseline, mid-intervention, post-intervention, and 1-month follow-up.

RESULTS

As a result, at 8 weeks, the active group yielded greater improvements in VAS, BDI, and SF-36 scores than the sham tDCS group. At follow-up, the tDCS group led to a greater improvement in VAS, PASE, and SF-36 scores compared to sham tDCS group (p < 0.05).

CONCLUSION

Our results suggest a beneficial effect of tDCS combined with PT in older adults with chronic musculoskeletal pain in the reduction of pain sensation, increment of physical activity level, increment of the quality of life, and reduction of depression incidents. This opens the possibility the possibility of using tDCS as a regular treatment for this population's physical and mental health.

Postoperative opioid prescribing patterns in the geriatric patient population

BACKGROUND

Opioid prescription patterns in elderly patients undergoing general surgery are not well characterized. The purpose of this study was to identify trends in postoperative opioid prescriptions in geriatric patients undergoing general surgery procedures and determine prescribing differences between the geriatric and non-geriatric patient population.

METHODS

We retrospectively evaluated geriatric and non-geriatric patients undergoing the most frequently performed open and laparoscopic general surgery procedures at our institution from 2014 to 2019. Differences in opioid prescriptions between the groups were analyzed.

RESULTS

We identified 5874 non-geriatric and 3306 geriatrics patients who underwent the included procedures at our institution. 5169 (88.0%) of non-geriatric patients and 2692 (81.4%) of geriatric patients received a perioperative opioid prescription. While the vast majority of both groups were prescribed opioids, geriatric patients were less likely to receive an opioid prescription (p < 0.0001). Between 2016 and 2019, the amount of opioid prescribed in the geriatric population decreased each year (p < 0.0001). Prescription amounts were significantly higher in geriatric patients aged 65-74 compared to patients 85 or older (p < 0.0001).

CONCLUSIONS

Individuals older than 65 years of age represent a growing percent of the population and there is a need to better understand opioid prescribing practices in this complex patient group. Postoperative opioid prescribing patterns differ significantly between the geriatric and non-geriatric patient population and warrant further investigation.

Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

Background

In recent years, a growing number of researchers showed significant interest in psychological and social interventions to manage chronic musculoskeletal (MSK) pain. Cognitive and emotional empathy is an attractive and valuable sociopsychological factor that may provide protection and resilience against chronic MSK pain. However, its effect on outpatients remains underexplored.

Objective

To compare the empathy ability between chronic MSK pain outpatients and healthy controls and explore the relationship between cognitive/emotional empathy and chronic pain.

Methods

Patients with chronic MSK pain (n = 22) and healthy controls (n = 26) completed the pain assessment and empathy ability task, utilizing a multidimensional empathy assessment tool with satisfactory reliability and validity (i.e., the Chinese version of the Multifaceted Empathy Test (MET-C)).

Results

The data indicated that the chronic MSK pain outpatients had impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy: Student's t = −2.119, P = 0.040, and longer task completion time: Student's t = 3.382, P = 0.002) compared to healthy controls, and cognitive empathy was negatively correlated with pain intensity (r = −0.614, P = 0.002). Further, the impaired cognitive empathy was present in identifying positive, but not negative emotions.

Conclusion

These results indicate that chronic MSK pain is associated with impaired empathy ability. Our studies contribute to offering a potential direction for developing psychosocial interventions to treat chronic MSK pain.

The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study

BACKGROUND

chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population.

OBJECTIVE

we examined the association between opioid use, and changes in cognitive function of older adults.

DESIGN

prospective study.

SETTING

community dwelling older adults.

SUBJECTS

study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia.

METHODS

medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models.

RESULTS

cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use.

CONCLUSION

prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.

Long-Term Efficacy of a Home-Care Hypnosis Program in Elderly Persons Suffering From Chronic Pain: A 12-Month Follow-Up

BACKGROUND

Pain is a major public health concern in the aging population. However, medication brings about negative effects that compel healthcare professionals to seek alternative management techniques to alleviate pain. Hypnosis has been recognized as an effective technique to manage pain, but its long-term efficacy has yet to be examined in older adults.

AIMS

The aim was to assess the effectiveness, over a 12-month period, of home-care hypnosis in elderly participants suffering from chronic pain.

DESIGN

Real-life retrospective one-arm study with a 12-month follow-up.

SETTINGS

Elderly Persons Suffering From Chronic Pain enrolled in a clinical health care program that offered home medical follow-up.

PARTICIPANTS/SUBJECTS

Fourteen elderly women (mean age 81 years) with chronic pain participated in the home-care hypnosis program. All participants presented chronic pain (≥6 months) with average pain score >4/10.

METHODS

Participants took part in seven 15-minute hypnosis sessions within 12 months. The Brief Pain Inventory questionnaire was used to evaluate pain perception and pain interference at baseline and at 3-, 6-, and 12-month follow-up period.

RESULTS

Hypnosis home-care program significantly decreased pain perception and pain interference compared to baseline after 3 months (-29% and -40%, p < .001), and remained lower at 6 (-31% and -54%, p < .001) and 12 (-31% and -47%, p < .001) months.

CONCLUSIONS

Seven sessions of 15 minutes allocated throughout a 12-month period produced clinically significant decreases in pain perception and pain interference. Hypnosis could be considered as an optimal additional way for health practitioners to manage chronic pain in an elderly population with long-term efficacy. This study offers a new long-term option to improve chronic pain management at home in elderly populations through a low-cost nonpharmacological intervention.

Sources of Individual Differences in Pain

Pain is an immense clinical and societal challenge, and the key to understanding and treating it is variability. Robust interindividual differences are consistently observed in pain sensitivity, susceptibility to developing painful disorders, and response to analgesic manipulations. This review examines the causes of this variability, including both organismic and environmental sources. Chronic pain development is a textbook example of a gene-environment interaction, requiring both chance initiating events (e.g., trauma, infection) and more immutable risk factors. The focus is on genetic factors, since twin studies have determined that a plurality of the variance likely derives from inherited genetic variants, but sex, age, ethnicity, personality variables, and environmental factors are also considered.

Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

Evaluating the impact of age and inflammatory duration on behavioral assessments of nociception

Pain is a prevalent issue for elderly individuals. Unfortunately, it remains unclear how acute and chronic pain differs as a function of age, and surprisingly, there is even disagreement on how the sensory and affective dimensions of pain change with age. Therefore, the current investigation evaluated such age differences with behavioral methodology using a preclinical model of arthritis. The primary factors of interest were age and chronicity of pain using behavioral assessments designed to measure sensory and affective dimensions of pain processing. Mechanical and thermal paw withdrawal thresholds demonstrated unique outcomes associated with sensory processing across age. The processing of pain affect measured by the Place Escape/Avoidance Paradigm (PEAP testing) also demonstrated age related effects. Overall, younger animals appeared more sensitive to nociceptive stimuli than older animals. However, the results from the current study suggest that chronicity of pain can be impactful for how older animals process pain related affect and avoidance. The finding of unique patterns of pain across age and duration of pain highlights the clinical literature. Future research should aim to elucidate mechanisms for affective processing of chronic pain in older subjects.

The influence of aging and duration of nerve injury on the antiallodynic efficacy of analgesics in laboratory mice

INTRODUCTION

Increasing attention is being paid to the effects of organismic factors like age on pain sensitivity. However, very little data exist on this topic using modern algesiometric assays and measures in laboratory rodents.

OBJECTIVES

We investigated the effect of age and duration of nerve injury on baseline mechanical thresholds, neuropathic allodynia, and the antiallodynic and analgesic efficacy of 4 systemically administered analgesics: amitriptyline, diclofenac, morphine, and pregabalin.

METHODS

Mice of both sexes and 3 conditions were compared: Young-Young, in which baseline testing (von Frey thresholds), the injury producing neuropathic pain (spared nerve injury [SNI]) and subsequent drug testing occurred while mice were young (8-10 weeks); Young-Old, in which mice received the nerve injury while young but were tested for drug efficacy over 10 months later; and Old-Old, in which both the nerve injury and drug testing occurred at approximately 1 year of age.

RESULTS

Old-Old mice were found to display higher baseline mechanical sensitivity than other groups. No group differences were seen in SNI-induced allodynia in males; female Young-Old mice were found to display greatly reduced allodynia. With respect to drug efficacy, no differences among conditions were observed for amitriptyline, diclofenac, or morphine. For pregabalin, however, Young-Old mice displayed significantly reduced antiallodynia, and the drug was completely ineffective in Old-Old mice.

CONCLUSION

Novel findings include the apparent remission of SNI-induced allodynia in female mice 10 months after injury and reduced pregabalin antiallodynic effects produced by both the passage of time after nerve injury and aging.

The Impact of Cognitive Anxiety and the Rating of Pain on Care Processes in a Vigilance Task: The Important Part Played by Age

Chronic pain is a serious public health problem that has grown exponentially in recent years, which is why it has received the attention of numerous researchers. Most of the studies in the field of chronic pain have focused on care as a mediating variable on the perception of painful stimuli and emotions. Nevertheless, there are very few studies that have gone in the opposite direction. This study's aim is therefore to analyse the impact of emotional variables (anxiety and depression), the rating of pain, and age on vigilance processes in a sample of patients with chronic pain. To do so, the attentional performance of a cohort of 52 patients with chronic pain was measured through the use of a modified dot-probe task. Furthermore, all the participants were evaluated using the following self-report measures: Beck's Depression Inventory-II (BDI-II), the McGill Pain Questionnaire, and the Pain Anxiety Symptoms Scale-20 (PASS-20). Stepwise multiple linear regression analysis revealed a significant negative correlation between the pain rating index and the number of mistakes the participants made during the attention test. There was also a positive and significant correlation with age and another negative and significant correlation with cognitive anxiety regarding the overall performance times during the undertaking of the experimental task. These results point to the importance of a more in-depth understanding of the impact that the emotional variables and other variables such as age have on attentional processes and the rating of pain. Finally, the discussion focuses on the implications these results could have for clinical practice or for future research studies in this field.

Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory

Chronic pain patients enter treatment with different problem profiles making careful assessment a necessity for more individualized treatment plans. In this cross-sectional study we assigned 320 patients entering tertiary multidisciplinary pain treatment into four categories based on whether they scored low or high on the activity and the affective pain interference dimensions of the Brief Pain Inventory (BPI). To determine whether this categorization system delineates issues that should be assessed further, the categories were compared with ANOVA and MANOVA analyses on three domains: variables affecting physical well-being (body mass index, exercise, substance use), psychological resources (mood), and pain-specific psychological factors (pain anxiety, pain acceptance). The results indicated that subjects who scored low on both interference dimensions compared similarly in weight: mean Body Mass Index (BMI) 27.0 (SD 6.0) kg/m², and exercise: mean of 2.4 (SD 1.7) exercising sessions over 20 minutes per week, to the general population, had no depressive symptoms on average: mean Beck Depression Index II (BDI-II) score 11.7 (SD 7.5), and had the most favorable psychological reactions to pain relative to the other categories: mean total Pain Anxiety Symptoms Scale-20 (PASS-20) score 36.4 (SD 17.9). In contrast, when interference was high on activity, more physical well-being problems were evident e.g. weight: mean BMI 31.0 (SD 7.3) kg/m², diminished exercise: mean of 1.5 (SD 1.6) exercising sessions per week, and avoidance behavior: mean PASS-20 Escape/Avoidance subscale 3.7 (95% CI: 1.7 to 5.8) scores higher in comparison to activity interference remaining low. With high affective interference, more depressive symptoms: mean BDI-II score 17.7 (SD 7.3), and more cognitive pain anxiety: mean PASS-20 Cognitive Anxiety subscale 2.8 (95% CI 0.7 to 4.8) scores higher in comparison to affective interference remaining low, emerged. Having high interference on both dimensions indicated accumulated risks for reduced physical well-being: mean BMI 29.9 (SD 6.1) kg/m², mean of 1.2 (SD 1.7) exercising sessions per week, mood problems: mean BDI-II 20.3 (SD 10.6), and negative psychological reactions to pain: mean total PASS-20 score 53.2 (18.4). The results suggest that low interference on both dimensions may allow assessment with only physician consultations, while high interference on either dimension may call attention to distinct issues to be addressed with the help of a physiotherapist or a psychologist, whereas high interference on both dimensions highlights the need for a full multidisciplinary assessment.

Chronic Pain Management in the Elderly

Chronic pain is extremely prevalent in older adults and is associated with significant morbidity, including limited mobility, social isolation, and depressed mood. Pain is defined by a biopsychosocial model highlighting the importance of a multidisciplinary approach to treatment, including multimodal medications, selected interventions, physical therapy and rehabilitation, and psychological treatments. In this narrative review, the authors highlight the use of these approaches in older adults with specific attention paid to considerations unique to aging, including alterations in drug metabolism, avoidance of polypharmacy, and physiologic changes predisposing to painful conditions.

Pain-related factors in older adults

BACKGROUND AND AIMS

Pain is an evident factor affecting the quality of life in all age groups. The objective was to examine the prevalence of self-reported SF-36 bodily pain and pain-related factors in community-dwelling older adults.

METHODS

One thousand four hundred and twenty adults aged 62-86 years self-reported SF-36 bodily pain during the previous month. For the analysis, four pain groups were formed (group I [0-45, moderate to very severe pain intensity and interference], group II [47.5-70], group III [77.5-90], and group IV [100, no pain at all]). Additional questionnaire-provided data regarding education, wealth, life habits, and morbidity, as well as clinical data were considered.

RESULTS

The overall pain prevalence was 78% (SF-36 bodily pain score <100). The prevalence of cohabiting, as well as the years of education and household income were found to decrease with an increasing SF-36 bodily pain score. The prevalence of a BMI of over 30 and of central obesity emerged as the highest in group I. Morbidities were found to be most prevalent in group I.

CONCLUSIONS

A high prevalence of intense and interfering pain was reported. Multiple factors that were found to relate to pain have previously been demonstrated to associate with social exclusion. Increasing attention should be paid to distinguishing these factors in patients with pain, as well as targeted pain assessment and measures to improve the sense of community among older adults.

IMPLICATIONS

There is a lack of large studies that examine a wide scale of pain-related factors in the older adult population. To distinguish subjects with multiple such factors would help medical professionals to target their attention to patients at a high risk of chronic pain.

Reiki therapy for pain, anxiety and quality of life

The use of complementary and alternative therapies is growing year after year, and Reiki therapy takes a place of choice. Reiki therapy, classed as a biofield energy therapy, raises the question of validity when applied to patients, especially in palliative care. The purpose of this review is to highlight the effects of Reiki therapy on pain, anxiety/depression and quality of life of patients, specifically in palliative care. The current article indicates that Reiki therapy is useful for relieving pain, decreasing anxiety/depression and improving quality of life in several conditions. Due to the small number of studies in palliative care, we were unable to clearly identify the benefits of Reiki therapy, but preliminary results tend to show some positive effects of Reiki therapy for the end-of-life population. These results should encourage teams working in palliative care to conduct more studies to determine the benefits of Reiki therapy on pain, anxiety/depression and quality of life in palliative care.

Behavioral Compensations and Neuronal Remodeling in a Rodent Model of Chronic Intervertebral Disc Degeneration

Low back pain is associated with degeneration of the intervertebral disc, but specific mechanisms of pain generation in this pathology remain unknown. Sensory afferent nerve fiber growth into the intervertebral disc after injury-induced inflammation may contribute to discogenic pain. We describe a clinically relevant behavioral phenotype in a rodent model of chronic intervertebral disc degeneration which provides a means to map sensory neuron changes to a single affected lumbar intervertebral disc. Unilateral disc puncture of one lumbar intervertebral disc revealed a bilateral behavioral phenotype characterized by gait changes and decreased activity. Moreover, neurons extracted from the dorsal root ganglia in animals with intervertebral disc injury demonstrated altered TRPV1 activation in vitro independent of exogenous NGF administration. Finally, neuronal nuclear hypertrophy and elevated expression of p75NTR provide evidence of active adaptation of innervating sensory neurons in chronic intervertebral disc degeneration. Therefore, this model and findings provide the template for future studies to establish specific mechanisms of nociceptive pain in chronic intervertebral disc degeneration.

Pain: The Neglect Issue in Old People's Life

BACKGROUND

As the elderly population increases dramatically, the chronic age-related disease should be noted. In the elderly, chronic pain is a common health problem.

METHODS

This search was performed in 3 databases (PubMed, Google Scholar, Embase). We have reviewed articles related to pain management in the elderly.

RESULT

The prevalence of pain in people aged above 60 is twice that in younger people. Pain is estimated to be 45-85 per cent in the elderly. Pain is not a part of the ageing process, but many older people can experience it. Perception of pain can be affected by environmental, emotional, cultural and cognitive factors. Pain in the elderly often remains untreated and misdiagnosed.

CONCLUSION

Pain management in elderly needs different approach because of unreported pain in this population, and usually they have multiple problems and comorbidities that complicate evaluation and treatment.

Quantifying and Characterizing Tonic Thermal Pain Across Subjects From EEG Data Using Random Forest Models

OBJECTIVE

Effective pain assessment and management strategies are needed to better manage pain. In addition to self-report, an objective pain assessment system can provide a more complete picture of the neurophysiological basis for pain. In this study, a robust and accurate machine learning approach is developed to quantify tonic thermal pain across healthy subjects into a maximum of ten distinct classes.

METHODS

A random forest model was trained to predict pain scores using time-frequency wavelet representations of independent components obtained from electroencephalography (EEG) data, and the relative importance of each frequency band to pain quantification is assessed.

RESULTS

The mean classification accuracy for predicting pain on an independent test subject for a range of 1-10 is 89.45%, highest among existing state of the art quantification algorithms for EEG. The gamma band is the most important to both intersubject and intrasubject classification accuracy.

CONCLUSION

The robustness and generalizability of the classifier are demonstrated.

SIGNIFICANCE

Our results demonstrate the potential of this tool to be used clinically to help us to improve chronic pain treatment and establish spectral biomarkers for future pain-related studies using EEG.

Effect of Age, Sex and Gender on Pain Sensitivity: A Narrative Review

Introduction:

An increasing body of literature on sex and gender differences in pain sensitivity has been accumulated in recent years. There is also evidence from epidemiological research that painful conditions are more prevalent in older people. The aim of this narrative review is to critically appraise the relevant literature investigating the presence of age and sex differences in clinical and experimental pain conditions.

Methods:

A scoping search of the literature identifying relevant peer reviewed articles was conducted on May 2016. Information and evidence from the key articles were narratively described and data was quantitatively synthesised to identify gaps of knowledge in the research literature concerning age and sex differences in pain responses.

Results:

This critical appraisal of the literature suggests that the results of the experimental and clinical studies regarding age and sex differences in pain contain some contradictions as far as age differences in pain are concerned. While data from the clinical studies are more consistent and seem to point towards the fact that chronic pain prevalence increases in the elderly findings from the experimental studies on the other hand were inconsistent, with pain threshold increasing with age in some studies and decreasing with age in others.

Conclusion:

There is a need for further research using the latest advanced quantitative sensory testing protocols to measure the function of small nerve fibres that are involved in nociception and pain sensitivity across the human life span.

Implications:

Findings from these studies should feed into and inform evidence emerging from other types of studies (e.g. brain imaging technique and psychometrics) suggesting that pain in the older humans may have unique characteristics that affect how old patients respond to intervention.

Laboratory environmental factors and pain behavior: the relevance of unknown unknowns to reproducibility and translation

The poor record of basic-to-clinical translation in recent decades has led to speculation that preclinical research is "irreproducible", and this irreproducibility in turn has largely been attributed to deficiencies in reporting and statistical practices. There are, however, a number of other reasonable explanations of both poor translation and difficulties in one laboratory replicating the results of another. This article examines these explanations as they pertain to preclinical pain research. I submit that many instances of apparent irreproducibility are actually attributable to interactions between the phenomena and interventions under study and "latent" environmental factors affecting the rodent subjects. These environmental variables-often causing stress, and related to both animal husbandry and the specific testing context-differ greatly between labs, and continue to be identified, suggesting that our knowledge of their existence is far from complete. In pain research in particular, laboratory stressors can produce great variability of unpredictable direction, as stress is known to produce increases (stress-induced hyperalgesia) or decreases (stress-induced analgesia) in pain depending on its parameters. Much greater attention needs to be paid to the study of the laboratory environment if replication and translation are to be improved.

Pharmacotherapies in Geriatric Chronic Pain Management

Pharmacologic management of chronic pain in older adults is one component of the multimodal, interdisciplinary management of this complex condition. In this article, we summarize several of the key barriers to effective pharmacologic management in older adults and review the existing (albeit limited) evidence for its effectiveness and safety, especially in a medically complex population with multimorbidity. This review covers topical formulations, acetaminophen, oral nonsteroidal antiinflammatory drugs, and adjuvant therapies. The article concludes with a suggested approach to managing chronic pain in the older patient, incorporating goals and expectations for treatment as well as careful monitoring of medication adjustments.

Age Differences in the Correlates of Physical Functioning in Patients With Chronic Pain

OBJECTIVES

Pain-related disability in the elderly is a major contributor to poor quality of life. In this study, the author examined age-related differences in the factors associated with physical disability in the context of chronic pain.

METHOD

A large cohort of chronic pain patients was categorized into four age groups, and correlates of physical disability were evaluated within each age category.

RESULTS

Several important age differences in the predictors of physical disability were noted. Affective distress was unrelated to physical disability among the elderly, whereas this association was quite strong among younger patients. In contrast, pain severity was a weak predictor of disability within the younger group, but it accounted for more than one fourth of the variance in physical disability in those older than 65.

DISCUSSION

These data suggest that the determinants of functioning may vary across the life span, implying a potential for pain management programs tailored to a patient's age.

[Pain in the elderly: Quality of life, functionality and associated factors. SABE Study, Bogotá, Colombia]

OBJECTIVE

To determine the impact of pain on the quality of life in older adults and its association with functionality.

MATERIALS AND METHODS

Data was taken from SABE Bogota study. A cross-sectional study was carried out during 2012, interviewing 2,000 individuals of 60 years and older, as a probabilistic cluster and representative sample. The variable 'presence of pain' to was used to identify associations with sociodemographic factors, self-rated health, comorbidities, functional status, cognitive status, and quality of life. The latter was estimated using a visual analogue scale of the EuroQOL tool (EQ-VAS).

RESULTS

The majority of older adults were women (63.4%); the mean age was 71.17 years (SD=8.05), with a higher frequency of individuals in the age group between 60 and 69years (48%). When comparing groups with pain vs. no pain, significantly lower scores were found in the group with pain (P<.001) in both the functionality and quality of life EQ-VAS scales. The strongest associations with pain were: joint diseases (OR: 3.08 [2.24-4.23]), severe depression (OR: 2.80 [1.63-4.79]) and functional impairment of the Basic Activities of Daily Living (BADL) (OR: 2.45 [1.31-4.58]).

CONCLUSIONS

Pain negatively impacts the functional independence and the perception of the quality of life in older adults, predisposing them to adverse outcomes.

The four or more medicines (FOMM) support service: results from an evaluation of a new community pharmacy service aimed at over-65s

OBJECTIVE

Inappropriate prescribing and nonadherence have a significant impact on hospital admissions and patient quality of life. The English government has identified that community pharmacy could make a significant contribution to reducing nonadherence and improving the quality of prescribing, reducing both hospital admissions and medicines wastage. The objective of this study is to evaluate a community pharmacy service aimed at patients over the age of 65 years prescribed four or more medicines.

METHODS

Patients were invited to participate in the service by the community pharmacy team. The pharmacist held regular consultations with the patient and discussed risk of falls, pain management, adherence and general health. They also reviewed the patient's medication using STOPP/START criteria. Data were analysed for the first 6 months of participation in the service.

KEY FINDINGS

Six hundred twenty patients were recruited with 441 (71.1%) completing the 6-month study period. Pharmacists made 142 recommendations to prescribers in 110 patients largely centred on potentially inappropriate prescribing of NSAIDs, PPIs or duplication of therapy. At follow-up, there was a significant decrease in the total number of falls (mean -0.116 (-0.217--0.014)) experienced and a significant increase in medicine adherence (mean difference in Morisky Measure of Adherence Scale-8: 0.513 (0.337-0.689)) and quality of life. Cost per quality-adjusted life year estimates ranged from £11 885 to £32 466 depending on the assumptions made.

CONCLUSION

By focussing on patients over the age of 65 years with four or more medicines, community pharmacists can improve medicine adherence and patient quality of life.

Health-Related Quality of Life and Pain Intensity Among Ethnically Diverse Community-Dwelling Older Adults

Chronic pain is highly prevalent in older adults and often negatively associated with health-related quality of life (HRQoL). This study compared HRQoL, including physical health and mental health, in persons of differing ethnicities, and identified factors associated with pain intensity and HRQoL in ethnically diverse older adults. Older adults with chronic pain from four ethnic groups (African Americans, Afro-Caribbeans, Hispanics, and European Americans) were recruited from the Florida Atlantic University Healthy Aging Research Initiative (HARI) registry. The Medical Outcomes Study Short Form-36 (SF-36) was used to evaluate HRQoL, including functional status, emotional well-being, and social functioning. Of 593 persons in the four ethnic groups in the registry, 174 met the inclusion criteria (pain level of four or higher on an 11-point scale, lasting 3 months or longer). Among these 174, African Americans reported the highest level of pain intensity, followed by Afro-Caribbeans, Hispanics, and European Americans. Hispanics reported the highest physical health scores and the lowest mental health scores. In contrast, African Americans reported the highest mental health scores and the lowest physical health scores. Multivariate linear regression analysis revealed that ethnicity, lower physical health scores, and lower mental health scores were significantly (p ≤ .01) associated with pain intensity. Understanding ethnic variations in response to pain intensity may address gaps in knowledge about HRQoL to reduce disparities in optimal care. Health care providers should consider ethnic norms and cultural diversity to provide optimal interventions for this population.

Non-opiate pharmacotherapy options for the management of pain in older adults

Pain is highly prevalent, costly, and disabling in later life, especially when undertreated. In this article, we aim to describe the risks and benefits of non-opioid medication options for the management of pain in adults aged 65 years and older in order to provide additional options in a practitioner's tool box when designing a pain management regimen for an older adult. Non-opiate pharmacologic therapies, such as acetaminophen, nonsteroidal anti-inflammatory drugs, topicals, and antidepressants have an important role in pain management of older adults. When designing a pain regimen, taking an individualized approach that considers the patient's functional status, comorbidities, and treatment goals will maximize pain management.

The understanding of pain by older adults who consider themselves to have aged successfully

OBJECTIVES

Despite an ageing population and an increased prevalence of chronic pain, the relationship between chronic pain and the concept of successful ageing is unclear. The aim of the present research was to explore older people's views on past and present experiences of pain, and its management, and how these experiences relate to their perceptions of successful ageing.

METHODS

Semi-structured interviews with six participants, aged 75 years or older, who considered themselves to have aged successfully, explored what this concept meant to them and their experiences of pain. Data analysis used methods drawn from grounded theory. The themes reported in this article are 'understanding of pain' and 'perceptions of ageing'.

RESULTS

None of the participants recalled painful experiences that were not attributable to physical trauma. They believed that pain is part of life and a natural consequence of the ageing process. While some accepted this with little resistance, others felt frustration at what they considered a dismissive attitude towards older people experiencing pain from healthcare practitioners. The concept of successful ageing was previously unfamiliar to participants, and their conceptualization of ageing derived from comparing themselves with their peers.

CONCLUSIONS

The findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain.

Choice of nonpharmacological pain therapies by ethnically diverse older adults

SUMMARY 

Aim: This study compared nonpharmacological pain therapies used by ethnically diverse older adults with recommendations of family physicians and identified factors associated with nonpharmacological pain therapies use. Methods: Using a descriptive cross-sectional design, 281 participants in four ethnic groups (European Americans, Hispanics, African–Americans, Afro-Caribbeans) with chronic pain were surveyed. Binary logistic regression analyses were employed to determine associated factors. Results & conclusion: Nonaquatic exercise and physical therapy were most frequently recommended by physicians, and nonaquatic exercise was most commonly used by participants. Lower pain levels predicted use of nonaquatic exercise, and ethnicity predicted use of prayer to manage chronic pain. Future research should examine barriers to use of psychological treatments and assess the value of combined physical and psychological treatments.

More attention to pain management in community-dwelling older persons with chronic musculoskeletal pain

BACKGROUND

persistent pain is a major problem in older people, but little is known about older persons' opinion about the treatment of persistent pain.

OBJECTIVE

the objective of this study was to investigate the factors associated with older participants having chronic musculoskeletal pain and hoping persistently that physician would pay more attention to the pain management.

METHODS

this 3-year follow-up study was a part of large population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. The population sample (n = 1000) of the GeMS study was randomly selected from older inhabitants (≥75 years) of Kuopio city, Finland, and participants were interviewed annually in the municipal health centre or in the participant's current residence by three study nurses. The current substudy included participants with chronic musculoskeletal pain (n = 270). Participants were asked specifically whether they hoped that more attention would be paid to pain management by the physician.

RESULTS

at baseline, 41% of the community-dwelling older participants with chronic musculoskeletal pain hoped the physician would pay more attention to pain management. Of those participants, 49% were still continuing to hope after 1 year and 31% after 2 years. A persistent hope to receive more attention to pain management was associated with poor self-rated health (OR: 2.94; 95% CI: 1.04-8.30), moderate-to-severe pain (OR: 3.46; 95% CI: 1.42-8.44), and the daily use of analgesics (OR: 4.16; 95% CI: 1.08-16.09).

CONCLUSION

physicians need to take a more active role in the process of recognising, assessing and controlling persistent pain in older people.

The effectiveness of psychological treatments for chronic pain in older adults: cautious optimism and an agenda for research

PURPOSE OF REVIEW

To explores the potential role of psychological treatments for older people who are affected by chronic pain.

RECENT FINDINGS

It is now widely recognized that chronic pain is a highly prevalent health problem among older people, and guidelines have evolved to assist with the assessment and management of chronic pain. However, despite the fact that psychological treatments have been shown to be effective for a range of other conditions such as depression and anxiety, there is a relative paucity of studies focused on pain management. Although more evidence is needed, the trend from existing studies indicates that older people find psychological treatments for chronic pain to be relevant, acceptable in content, and beneficial in reducing distress and disability. Particular challenges arise for the delivery of psychological interventions to people with pain and cognitive impairment associated with dementia. There is a growing interest in this population and a good deal of research has focused on the assessment of pain, but with a small number of exceptions, almost no research activity as yet in developing psychological treatments for people with pain and dementia.

SUMMARY

We conclude that there is sufficient evidence that psychological interventions are efficacious for older people with chronic pain. We propose a number of areas for research focus over the next 10 years that will help to consolidate our knowledge and to explore new avenues for the psychological management of chronic pain in older people.

Systematically searching for and assessing the literature for self-management of chronic pain: a lay users' perspective

BACKGROUND

The Engaging with older adults in the development of strategies for the self management of chronic pain (EOPIC) study aims to design and develop self management strategies to enable older adults to manage their own pain. Involving older adults in research into chronic pain management will better enable the identification and development of strategies that are more appropriate for their use, but how can perspectives really be utilised to the best possible outcomes?

METHOD

Seven older adults were recruited through a local advertising campaign to take part. We also invited participants from the local pain services, individuals who had been involved in earlier phase of the EOPIC study and a previous ESRC funded project. The group undertook library training and research skills training to facilitate searching of the literature and identified sources of material. A grading tool was developed using perceived essential criteria identified by the older adults and material was graded according to the criteria within this scale.

RESULTS

Fifty-seven resources from over twenty-eight sources were identified. These materials were identified as being easily accessible, readable and relevant. Many of the web based materials were not always easy to find or readily available so they were excluded by the participants. All but one were UK based. Forty-four items were identified as meeting the key criteria for inclusion in the study. This included five key categories as follows; books, internet, magazines, leaflets, CD's/Tapes.

CONCLUSION

This project was able to identify a number of exemplars of self management material along with some general rules regarding the categories identified. We must point out that the materials identified were not age specific, were often locally developed and would need to be adapted to older adults with chronic pain. For copyright issues we have not included them in this paper. The key message is really related to the format rather than the content. However, the group acknowledge that these may vary according to the requirements of each individual older adult and therefore recommend the development of a leaflet to help others in their search for resources. This leaflet has been developed as part of Phase IV of the EOPIC study.

Aromatherapy: does it help to relieve pain, depression, anxiety, and stress in community-dwelling older persons?

To examine the effectiveness of an aromatherapy programme for older persons with chronic pain. The community-dwelling elderly people who participated in this study underwent a four-week aromatherapy programme or were assigned to the control group, which did not receive any interventions. Their levels of pain, depression, anxiety, and stress were collected at the baseline and at the postintervention assessment after the conclusion of the four-week programme. Eighty-two participants took part in the study. Forty-four participants (37 females, 7 males) were in the intervention group and 38 participants (30 females, 8 males) were in the control group. The pain scores were 4.75 (SD 2.32) on a 10-point scale for the intervention group and 5.24 (SD 2.14) for the control group before the programme. There was a slight reduction in the pain score of the intervention group. No significant differences were found in the same-group and between-group comparisons for the baseline and postintervention assessments. The depression, anxiety, and stress scores for the intervention group before the programme were 11.18 (SD 6.18), 9.64 (SD 7.05), and 12.91 (SD 7.70), respectively. A significant reduction in negative emotions was found in the intervention group (P<0.05). The aromatherapy programme can be an effective tool to reduce pain, depression, anxiety, and stress levels among community-dwelling older adults.

Clinical trial participants' experiences of completing questionnaires: a qualitative study

OBJECTIVES

To improve clinical study developments for elderly populations, we aim to understand how they transfer their experiences into validated, standardised self-completed study measurement instruments. We analysed how women (mean 78±8 years of age) participating in a randomised controlled trial (RCT) cognised study instruments used to evaluate outcomes of the intervention.

SETTING

The interview study was nested in an RCT on chronic neck pain using common measurement instruments situated in an elderly community in Berlin, Germany, which comprised of units for independent and assisted-living options.

PARTICIPANTS

The sample (n=20 women) was selected from the RCT sample (n=117, 95% women, mean age 76 (SD±8) years). Interview participants were selected using a purposive sampling list based on the RCT outcomes.

OUTCOMES

We asked participants about their experiences completing the RCT questionnaires. Interviews were analysed thematically, then compared with the questionnaires.

RESULTS

Interviewees had difficulties in translating complex experiences into a single value on a scale and understanding the relationship of the questionnaires to study aims. Interviewees considered important for the trial that their actual experiences were understood by trial organisers. This information was not transferrable by means of the questionnaires. To rectify these difficulties, interviewees used strategies such as adding notes, adding response categories or skipping an item.

CONCLUSIONS

Elderly interview participants understood the importance of completing questionnaires for trial success. This led to strategies of completing the questionnaires that resulted in 'missing' or ambiguous data. To improve data collection in elderly populations, educational materials addressing the differential logics should be developed and tested. Pilot testing validated instruments using cognitive interviews may be particularly important in such populations. Finally, when the target of an intervention is a subjective experience, it seems important to create a method by which participants can convey their personal experiences. These could be nested qualitative studies.

TRIAL REGISTRATION NUMBER

ISRCTN77108101807.