Persistent Pain Worsens Physical Function and Mental Health in Seniors

By Pat Anson, PNN Editor

Having persistent pain in your senior years is very common and contributes to declines in physical function and mental health, according to large new study that calls for more proactive treatment of pain in older adults.

“The findings from this study point to the importance of access to effective treatment for persistent pain in older adults and the need for additional research in chronic pain to optimize quality of life,” said lead author Christine Ritchie, MD, Director of the Mongan Institute Center for Aging and Serious Illness at Massachusetts General Hospital.

Ritchie and her colleagues analyzed health data for nearly 5,600 Medicare beneficiaries aged 65 and older who participated in the National Health Aging Trends Study from 2011 to 2019. Nearly 39% of participants reported having “persistent pain” and almost 28% had “intermittent pain.”  Only about a third of older adults (33.5%) reported having no “bothersome pain.”

Researchers found that seniors with persistent pain were more likely to report depression and anxiety, and to have three or more comorbid conditions such as a heart attack, stroke or cancer than those with intermittent or no pain. They were also more likely to have lower scores for mood and self-care activities such as eating, hygiene and dressing.

Perhaps the only good news is that differences were not found in cognitive impairment or dementia between those with and without persistent pain.

“This study is the first to include a representative sample of older Americans that demonstrates meaningful declines in physical function and well-being among those with persistent pain,” researchers reported in the Journal of the American Geriatrics Society.

“Given the high prevalence of persistent pain and its negative effects on both function and well-being, domains of the lived experience highly valued by older adults, it is incumbent on clinicians to prioritize strategies to effectively address their persistent pain.”

The researchers said many older adults lack access to effective nonpharmacological therapies and receive little guidance from primary care physicians about pain treatments.

Participants with persistent pain were more likely to be female, low-income, have limited education, and to be living alone – findings that mirror those of a 2020 study that found less-educated, working class Americans had higher rates of pain, social isolation, drug abuse, disability and suicide.  

A recent study in the UK found that having chronic pain in middle age significantly raises the chances of having pain and poor overall health in your senior years.

Leaving Pain Untreated is Torture

By Janice Reynolds, Guest Columnist

One thing we need to keep in mind when discussing the so-called opioid epidemic is that people in acute pain are being persecuted and harmed, as well as those with persistent (chronic) pain. In fact, much of the witch hunt may have started with acute pain.

It has long been known that when acute pain is left untreated or undertreated it can lead to persistent pain, as well as a multitude of harmful side effects from pain.  I know my persistent post-craniotomy pain was at least partially caused by poor pain treatment after my surgery. Eight years later, I can still vividly recall the second night post-op, when the pain was horrendous. I cried and really wanted to die.

People in pain have always experienced prejudice and bias.  The current situation has allowed bigots to speak and act with impunity.  As with anything, you tell a lie often enough and it must be true.

Anyone who has worked in medicine has heard a physician, nurse, pharmacist, physical therapist, etc. make derogatory statements, refuse to prescribe appropriate medication, express opiophobia, and sometimes even hatred for people in pain.  Sometimes it can even be family members. 

I have two favorite stories that I’ll share. And believe me, after over 20 years as an advocate for people in pain, I have a lot of stories.

As a new nurse, I once had a patient admitted with severe abdominal pain and headaches. The doctor would only give her Tylenol.  He would go off duty, and I would call the covering physician and get morphine ordered.  The doctor would come in the next morning and discontinue the morphine, leaving her with nothing but Tylenol. 

The patient was diagnosed with cancer, and the doctor claimed her pain was just a reaction to her diagnosis (and some nurses bought into that!). 

I finally couldn’t take it anymore and told the family they could request another doctor (I could have lost my license for coming between a doctor and his patient). I suggested an oncologist, who was also a palliative care doctor, who I knew as compassionate and good at pain management.

The oncologist took over and got her comfortable. She died two weeks after the admission for acute pain.

The second story was in the midst of the AIDS epidemic. I had a patient who was dying (she had been a prostitute and IV drug user).  When I attempted to get more morphine for her because she was literally writhing in pain, the doctor refused, saying, “She should have considered her lifestyle choices before.”

In 2001, when the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) came out with the first standards for pain assessment, we were ecstatic.  We were going to make pain visible and more people would get better treatment. 

Unfortunately, that is not how it worked out.  The anti-opioid activists were vocal about how the standards would push doctors to prescribe opioids, enable drug seeking, and so on.  Some even blamed the pharmaceutical industry, even though it had absolutely nothing to do with the standards. They were written by a professor of pharmacology and a nurse practitioner experienced in pain.

Fifteen years later, so many of these myths were still circulating that the Joint Commission felt compelled to come out with a statement refuting them.

Many actions now being taken affect acute pain care the most, such as removing pain questions from patient satisfaction surveys and poor treatment in hospital emergency rooms.  A hospital in New Jersey won praise and international attention for sharply reducing the use of opioids, until it was found to be in the bottom 3% of hospitals nationwide for quality of care.

Now they want to prevent opioids from being ordered for so called “minor” procedures and to limit the amount of opioids or number of days they can be prescribed for acute pain. And although pain care for cancer patients and the terminally ill is still touted as sacred, it isn’t as good as it should be and is losing ground.

You would think because pain can affect anyone at anytime that there would be more compassion. Yet we have politicians saying, “Yes, children need their pain relieved, however with the opioid epidemic they shouldn’t be receiving these powerful drugs” or “We need to be able to objectively measure pain.”

Torture, for the most part, relies on pain.  I realize there is water boarding and psychological torture, however inflicting pain is the method used throughout history. Politicians and the media are against torture, yet they do not see the mistreatment of pain as torture. It is actually torture of the worst kind, perpetuated by those who profess to have your best interests at heart.

A quote I always used in my classes and presentations comes from The Culture of Pain by David B. Morris:

“Failure to relieve pain comes perilously close to inflicting it.”

Janice Reynolds is a retired nurse who specialized in pain management, oncology, and palliative care. She has lectured across the country on pain management and is co-author of several articles in peer reviewed medical journals. 

Janice has lived with persistent post craniotomy pain since 2009.  She is active with The Pain Community and writes several blogs for them.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Why We Must Ditch the Term 'Chronic Pain'

By Janice Reynolds, Guest Columnist

The term “chronic pain” is being used as a weapon against people living in pain.  People who are prejudiced and biased against pain sufferers often use it in derogatory way, to imply their pain is not that bad or that they are even lying about it.

Over 15 years ago, some members of the American Society for Pain Management Nursing, including myself, recognized the negative connotation of the term and attempted to change it to “persistent pain,” obviously without much success. 

“Chronic” only means a time frame of 3 months or more. No one knows how it became a term to mean a “type” of pain. 

When I was an oncology nurse, I did some research on the biological differences between cancer pain and “non-cancer” pain, and didn’t find any. No one knew how the differentiation came to be. There was no evidence to support it.

Chronic pain does not exist as an entity; it applies to many different types of pain syndromes and diseases. So when someone says there is no evidence to support using opioids for chronic pain or that opioids make chronic pain worse, these are outright lies. Or if you want to be kinder, false assumptions based on erroneous evidence. Research based on false principles.

One of the things the so-called opioid epidemic has done is given some validity to these prejudices and biases to justify the war on people in pain. The abuse by politicians and the media is too complicated to go into here, but when you have someone like Sen. Susan Collins of Maine saying pain management is important for cancer patients or end-of-life care, but addiction is a bigger problem for chronic pain patients, then it is obvious that “chronic pain” is being used as a bludgeon.

What is one thing people in pain, advocates and providers can do?

Stop using the term “chronic pain” and start using the condition or disease that causes the pain.

I have persistent post craniotomy pain, for example. You might have pain from fibromyalgia. Or pain from arachnoiditis, rheumatoid arthritis, shingles, migraine, peripheral neuropathy, Ehlers-Danlos syndrome, and so on.  Be specific. There are many reasons for back pain, neuropathies and other syndromes.

When we talk or write about persistent pain, use the terms “people in pain” or “people living in pain.” I want organizations to throw the term “chronic pain” out as well. How much more supportive is the name “American Association for People in Pain” as opposed to the American Chronic Pain Association?

This will be a difficult paradigm to change, especially for professionals and journalists. But without change, “chronic pain” will continue to be used as a tool for hate.  

Janice Reynolds is a retired nurse who specialized in pain management, oncology, and palliative care. She has lectured across the country at medical conferences on different aspects of pain and pain management, and is co-author of several articles in peer reviewed journals. 

Janice has lived with persistent post craniotomy pain since 2009.  She is active with The Pain Community and writes several blogs for them, including a regular one on cooking with pain. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.