A Nurse’s Guide for Chronic Pain Management in the Elderly

• The nurse plays a vital role in assisting the elderly with chronic pain management, and performing an accurate assessment is paramount. 
• Pain is not a normal part of the aging process, and it sometimes goes untreated due to various barriers.  
• It is essential to understand the consequences of untreated pain and how the elderly who are nonverbal communicate pain. 

A standard, long-held belief is that pain is a normal aging process. But it’s not – even though a majority of older adult’s experience pain regularly. 

Pain is widely undertreated in older adults due to various barriers involving the patient and their families, healthcare professionals, and the healthcare system. Let’s discuss common chronic pain conditions, the barriers to chronic pain management, and interventions.   

Common Chronic Pain Conditions Among the Elderly

• Fibromyalgia: a disorder characterized by widespread musculoskeletal pain and accompanied by fatigue, sleep, memory, and mood issues.   
• Gout: characterized by severe pain, redness, and joint tenderness. Pain and inflammation occur when too much uric acid crystallizes and deposits in the joints.  
• Neuropathies (Diabetic and Postherpetic neuropathy): neuropathy is weakness, numbness, and pain from nerve damage, usually in the hands and feet.  Diabetic neuropathy is a type of nerve damage that can occur in patients with diabetes. This condition most often affects the legs and feet. For some patients, the symptoms are mild. For others, symptoms can be painful, debilitating, and even fatal. Postherpetic neuropathy is a neuropathic pain syndrome characterized by pain that persists for several months to years after the resolution of the herpes zoster rash. It is caused by damage to the peripheral and central neurons that may be a byproduct of the inflammatory response.
• Vitamin B complex deficiencies: peripheral neuropathy can result from vitamin B12 deficiency. Depending on the nerve involved, it may present as pain, numbness, tingling, loss of sensation, decreased motor activity, or decreased muscle mass.
• Osteoarthritis: a type of arthritis that occurs when flexible tissue at the ends of bones wears down. It happens gradually and worsens over time.   
• Osteoporosis: a condition in which bones become weak and brittle. In osteoporosis, new bone creation does not keep up with old bone removal.  
• Fractures: complete or partial breaks in bones. Causes of fractures include falls, overuse, and diseases, such as osteoporosis, that weaken bones.  
• Polymyalgia Rheumatica: an inflammatory disorder causing muscle pain and stiffness around the shoulders and hips.   

Barriers to Chronic Pain Management Among the Elderly 

Three significant sources are known to be barriers to chronic pain management in the elderly: the patient/family, healthcare professionals, and the healthcare system.   

Patient and Family Barriers

• Fear of medication side effects  
• Concerns relating to addiction  
• Concerns that by discussing pain, they may be seen as a “difficult patient”  
• Pain is thought to be a normal part of aging 

Healthcare Professional Barriers  

• Lack of education about pain assessment and management  
• Concern regarding regulations   
• Fears of opioid-related side effects  
• Assumption that pain is part of aging and cannot be managed  
• Lack of ability to assess pain in the cognitively impaired    

Healthcare System Barriers 

• Cost  
• Time  
• Cultural biases regarding opioid use  

Consequences of Undertreated Chronic Pain

Undertreated chronic pain has significant functional, emotional, and mental consequences. These consequences are decreased activity and ambulation, gait disturbances and injuries from falls, sleep disturbances, and sleep deprivation.   

Due to the increased use of healthcare services, caregivers or family members also experience increased financial burdens. All these issues diminish the elderly patient’s quality of life.     

Role of Pain Assessment in Chronic Pain Management

Nurses are usually the first and primary healthcare professionals to hear a patient’s reports of pain. For this reason, the nurse’s ability to perform a thorough pain assessment is critical in managing chronic pain.   

A thorough pain history, physical examination, and other testing, as necessary, will help manage chronic pain in the elderly patient. 

Elderly Patients Unable to Verbally Express Pain  

 Older adults who cannot give a verbal self-report of pain due to communication problems or cognitive impairment should be closely observed for pain behaviors. Manifestations of pain behaviors include:  

• Agitation  
• Confusion  
• Social withdrawal  
• Apathy  

Other pain indicators may include:  

• Grimacing or frowning  
• Shouting or moaning  
• Pacing or rocking  
• Isolation  
• Protecting a particular area of the body  

Nurse Interventions for Better Pain Management Among the Elderly

Nurse and Caregiver Education: Ensure you and other staff are adequately educated on the indicators of pain when the patient cannot verbally express pain and what to do when these indicators are observed.    

Pain Assessment Education for the Nurse: Ensure you thoroughly understand the importance of pain assessment and how to complete a pain assessment.  

Patient Education on Pain Treatment Options (pharmacologic and non-pharmacologic interventions): We are offering both medicines for pain treatment and alternatives to medicinal treatment, such as heat, ice, or physical therapies, and the benefits of both.

Patient and Family Education on Medication Side Effects and the Safety of Opioids in the Healthcare Setting: Educate the family and patients on the side effects of all the medications they are taking for pain. Make sure they know that these are just potential side effects of the drug, and it doesn’t necessarily mean they will be experienced. Opioids given in a healthcare setting are carefully administered and patients are closely monitored by both nurses and their physicians for adverse effects or signs of opioid dependency.

Ensuring All Scheduled Pain Medications are Given as Ordered and On Time: Successful pain management of the elderly patient is best achieved when scheduled pain medications are given on time to prevent gaps in pain control.   

The Bottom Line

Due to barriers in the healthcare system, the elderly patient is at significant risk for undertreatment of pain. To best meet the pain-related needs of these aging patients, nurses should be able to assess and treat pain as soon as possible. A thorough pain assessment is critical because that information will guide the patient’s care plan. This will also help the nurse and other healthcare team members achieve a higher quality of life for the elderly patient.   

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