Coping with pain

Older people often experience pain as they can have multiple medical problems. Pain can have a significant impact on an older person's ability to function on a daily basis.  

In this article:

• What is pain?
• Types of pain
• Pain assessment
• Detecting pain in someone with dementia
• Keeping a pain diary
• Medications and pain relief
• Relieving pain through non-drug methods
• Working with your doctor

What is pain?

Pain is an unpleasant sensory experience that can affect everyday life. Everybody experiences pain in their own way. Pain can affect sleep, appetite, the ability to move and make getting through the day that much harder.

Some people as they age get "used to their pain" or are reluctant to complain. Others with progressive degenerative diseases such as Alzheimer's, rely on their carers to detect their pain. 

Types of pain

Pain in the older adult can be related to injury, musculoskeletal problems, cancer or other chronic diseases. Pain can be acute or chronic, mild to severe. 

There are many different types and intensities of pain and it is often described as aching, throbbing, stabbing, shooting or burning.  

Pain assessment

Anyone with pain should consult their doctor. A doctor will want to get a clear picture of a person's pain and will ask lots of questions. This assessment helps them understand and manage a person's pain better.

Finding the right treatment for someone's pain could take time and a doctor may use a variety of medicines or other methods until they find what works best for the person.

Other health professionals could also be involved in assessing a person's pain such as a pain consultant or palliative care professional.

A doctor may ask:

• To describe the pain, is it dull, aching, throbbing, stabbing, coming and going, around all the time? 
• Where is the pain?
• Is the pain ongoing or does the pain come and go?
• What makes the pain feel better or worse?
• Does the person take anything for pain and does it help?
• What other methods help control the pain? (changing position) 

Detecting pain in someone with dementia

People with dementia may not always be able to communicate discomfort and often pain goes unnoticed. Signs of pain may be mistaken for anger or difficult behaviour.

People with dementia may react to pain by suddenly altering their behaviour or making distinct facial gestures.

In general, signs that may indicate pain or discomfort are:

• Grimacing
• Wincing
• Moaning
• Crying
• Restless
• Difficulty sleeping
• Flinching
• Nausea
• Vomiting
• Rapid breathing
• Pale and clammy
   

Carers can help a loved one by learning cues to pain. Always observe for changes after any analgesia has been given to monitor its effect and discuss these changes with your doctor.

Keeping a pain diary

By recording pain as it happens in a pain diary you can help determine when pain is occurring. For instance, for someone who is very frail, showering can be exhausting and cause much discomfort. If you can anticipate what activities may cause pain and if there is a pattern to the pain you can adjust a person's routine, activities or medications for more effective pain relief.

If you are caring for someone who cannot communicate effectively, write down any observations of pain and what activity they were undertaking at the time and show this to their doctor. Medication can usually be adjusted to have the most benefit.  

Medications and pain relief

There are lots of different medicines available for pain relief. Some of these you can only get on prescription, others you can purchase from the supermarket.

The most common form of pain relief is Paracetamol. Older people should be particularly careful when taking any medication as changes to the ageing body can effect the absorption and metabolism of drugs increasing the risk of side effects.

Always read the label and take only as directed. There are many different names for Paracetamol available over the counter. Be careful not to double up on medicine. Check for the active ingredient (Paracetamol) and do not exceed the recommended dose. Ask your doctor or pharmacist for advice.

People with chronic illness or advanced dementia may be given opioid analgesics. Sometimes older people or families are reluctant for doctors to prescribe opioid analgesics due to fear of addiction, delirium or serious side effects.

If taken and monitored correctly these drugs are safe and effective pain relievers. Always talk to a doctor or nurse about any medications prescribed if you have any concerns.  

Relieving pain through non drug methods

No one should put up with their pain. Management of pain can include many other strategies along with pain medications including:

Changing position

Being in the one position for too long can cause discomfort. Try to change a person's position or position the person with pillows and seat cushions for extra comfort.

Gentle massage and hot/cold packs

Massaging sore spots helps relax the muscles. Using hot and cold packs on sore areas can also relieve pain. Hot packs can relieve muscular pain and cold packs can help with pain caused by inflammation or swelling. Be very careful with heat packs as frail older skin can burn easily.

Acupuncture/TENS/Hypnosis

Acupuncture can be an effective way to ease pain for some people. Transcutaneous electrical nerve stimulation (TENS) uses electrical currents through the skin to deliver safe and effective pain control. Some people find hypnosis improves their ability to cope with pain.

Create a relaxing environment

Try to create a pleasant environment. Music, aromatherapy, reading or watching TV can take a person's mind off their pain. Relaxation methods such as listening to meditation tapes can help with pain management.

Working with your doctor

A person should always consult their doctor about their pain. Most people can improve their pain with good pain management. Pain can usually be managed by using non -drug methods along with pain medications.

If you are caring for someone with pain be aware of the side effects of pain medications. A doctor may rely on your observations to help establish effective pain control.

Let the doctor know when pain symptoms suddenly worsen. If current medications don't work ask to try new medications until the pain is relieved.

Pain is not a normal part of ageing and unfortunately many older people don't complain about their pain. They may use words other than pain to descibe their discomfort like ache, sore and heaviness.

Trouble sleeping, depression and decreased activity level may be indications that a person is in pain. Letting a doctor know about changed routines and behaviours can be another way of starting a conversation about pain.

References

The AGS Foundation for Health in Aging
Elder care at home: Chapter 11 - Pain
Accessed 20/5/09

Palliative Care Australia
Booklet: Facts about morphine and other opioid medicines in palliative care
May 2006