Nursing - Teaching Pain Management

A complex and unpleasant sensory and emotional experience, pain is a symptom. It’s never normal. When pain lasts beyond the time of healing or continues 3 months or longer, it’s classified as chronic.

Unlike graying hair and wrinkled skin, chronic pain is not part of the normal aging process. While chronic pain has many possible causes, each type of pain has its own unique quality. (See the box below.)

Many older adults with chronic pain experience depression, which can hinder their ability to cope with pain. Additionally, pain may worsen cognitive dysfunction and malnutrition.

One study found that along with financial hardship and certain other factors, chronic pain contributed to distress and depression among community-dwelling elderly adults. The chronic pain of arthritis interfered with daily activities, making it hard for them to carry out ADLs, which in turn led to distress. In this study, chronic pain was linked directly to depression. The author suggested that although people might be able adapt to chronic pain and may not appear to be distressed on a daily basis, pain may have long-term effects manifesting in depression.

A recent study of older women with chronic pain surveyed three groups using the Pain Disability Inventory and additional instruments. Women in two of the groups had greater daytime dysfunction due to chronic pain than those in the other group, along with significantly higher ratings on the Beck Depression Inventory. These groups rated their social functioning, general health, physical functioning, and mental health significantly lower than women in the first group.

Assessment

Assessing chronic pain in older adults can be challenging because this population tends to underreport pain. Also, unlike patients with acute pain, those with chronic pain generally don’t manifest autonomic pain responses, such as increased heart rate and respirations.

Using a pain scale is helpful when assessing an older adult for pain. Otherwise, your patient may respond to a question about pain with a vague statement such as, “No worse than usual” or “It’s the same old pain” or “It’s a part of getting old.” Encourage the patient to keep a pain diary to help identify events that precipitate or increase pain. A pain diary also can yield clues to the occurrence of breakthrough pain. If assessment findings suggest your patient has chronic pain, try to find out whether and to what extent the pain has affected quality of life.

Diane Marie Colley-Urquhart is municipal politician and Calgary Police Commissioner from Calgary, Alberta, Canada. She is currently a member of Calgary City Council and serves as the representative for Ward 13.
Diane Colley-Urquhart grew up on a farm in Oyen Alberta prior to moving to Calgary. After receiving her BSc in Health and Human...