Barriers to Effective Pain Management in Senior Care

While pain is not a normal part of aging, it does accompany many comorbid conditions and disorders including arthritis, diabetes, multiple sclerosis, and many types of cancer. Older adults may be reluctant to express their pain and simply “live with it” and may do so for a number of reasons. In the case of cognitive impairment, old adults may simply be unable to communicate that they are in pain. Others may feel that they are a burden and say nothing. Some may fear becoming addicted to pain medication. Regardless of the reasons, there are many barriers to effectively treating pain, especially in senior care.

Barriers to Pain Management

The American Society for Pain Management Nursing (ASPMN) believes in optimal pain and symptom management to alleviate any suffering for every senior receiving care, especially end of life care. Still, there are barriers that get in the way of providing treatments that will reduce or eliminate pain. What are these barriers?

The older adult or their family may be in denial of pain, fear the side effects of pain medication, and believe that pain is a natural part of the aging process and cannot be relieved. Others fear addiction.

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Healthcare professionals and caregivers may not recognize the signs and symptoms of pain among older adults and seniors under their care. These professionals may also be in denial. Some healthcare professionals may be unaware of the psychological, social and cultural aspects of pain. Can psychological pain be worse than physical pain? Do certain cultures view pain in spiritual ways? Some caregivers may feel they are doing more harm than good by providing pain medications.

The health care system itself may provide multiple barriers to effective pain and symptom management among older adults and seniors in nursing care. The costs of providing effective care are always under scrutiny and may get in the way of effective treatment. Restrictive drug formularies provide another barrier. The limits placed on medications in skilled nursing and other medical institutions does not add up to adequate or optimal pain management. Formularies also dictate which drugs will and will not be covered by insurance.

Understanding Pharmacological Management of Pain

Other barriers include understanding which choice of pain medication to use for a variety of pain types, symptoms, and causes. There are certain types of pain that are more difficult to treat than others like neuropathic pain. Chronic pain, too, may be a real challenge due to its unknown origin or causes. Inflammation may cause pain until it is effectively treated. Relieve inflammation and the level of pain should improve.

Commonly Used Pain Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are available both over-the-counter and by prescription at larger doses. These are used to reduce swelling and inflammation that contribute to pain.

Opioids, on the other hand, are narcotic drugs including codeine and morphine. These require a physician’s prescription and should be used with caution because they are known to cause sedation. They can also be life-threatening when used inappropriately.

Corticosteroids, such as prednisone and cortisone reduce swelling and inflammation, which in turn help to reduce pain. They are also known to reduce immune system activity, increase high blood pressure and increase the risk of osteoarthritis in older women.

Antidepressants are being used more now due to their effectiveness in managing certain types of pain and without many of the side effects of pain medications. Tricyclics like Elavil and Tofranil help increase the body’s production of serotonin which reduce the number of pain signals that reach the brain. Cymbalta and Effexor, both serotonin-norepinephrine reuptake inhibitors (SNRIs), may be prescribed for diabetic peripheral neuropathic pain, fibromyalgia, chronic musculoskeletal pain, and other chronic pain conditions. These medications increase the risk for high blood pressure and should be monitored closely.

Anticonvulsants, usually prescribed to treat seizure disorders, are also used at times in the treatment of pain and require a physician’s prescription. They are especially used to treat pain caused by neuropathic disorders including diabetes, shingles, herniated disk and chemotherapy. They may also be helpful in treating migraines by inhibiting certain kinds of nerve transmissions.

Last, topical analgesics are routinely prescribed as a first-line of treatment and are seen as the least risky and safer option for treating older adults and seniors with pain. Some may be over-the-counter and come in a cream or balm form or patches. They work by disrupting the pain cycle by giving sensory nerves another sensation to focus on like the cooling sensation produced by menthol.

Final Words on Pain Management in Senior Care

As you can see, there are multiple ways to treat pain and many that I haven’t touched upon at all, including non-pharmaceutical methods (e.g. massage, hot and cold therapy, physical therapy, acupuncture and relaxation). Pain will not be effectively treated unless it is understood and recognized by the healthcare professional and caregiver. It is, therefore, important to continue learning as much as possible about aging, pain, and the many ways to prevent, reduce, or treat it.