While arthritis is the most common cause of pain for people over age 65, circulatory problems, shingles, certain bowel diseases and cancer are other common reasons for pain in older people. Nerve damage can also cause severe and constant pain.
Some people think that pain is natural with old age or that when older people are not clear in explaining the cause of their pain they are just complaining. Both of these views are wrong. There is almost always a real problem behind the aches and pains.
Pain can lead to other problems. People with pain may lose the ability to move around and do everyday activities. They may have trouble sleeping, experience bad moods and have a poor self-image. People with pain also often have anxiety or depression. They may be at greater risk for falls, weight loss, poor concentration and difficulties with relationships.
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Most pain can be controlled, usually through a combination of drug and non-drug strategies, which should be discussed with a healthcare provider.
Caring for someone in pain or at risk for pain is often an ongoing process. As various strategies are tried, it may help to keep in mind two basic principles:
- Believe the person you are caring for. People with pain are the only ones who know how much pain they are feeling. Pain is whatever the older person says it is and exists whenever he or she says it does. If people with pain feel that others do not believe them, they become upset and may stop reporting their pain accurately. This makes controlling the pain more difficult.
- Every person has the right to good pain control. Your job as a caregiver is to make sure that good pain control is provided. Tell health professionals if pain does not improve with treatment and ask them to try new treatments until the pain is controlled. Your goals are to help evaluate and relieve pain and to keep health professionals informed about pain levels and responses to pain treatments.
What You Can Do to Help
- Ask about the pain. No medical test can tell you whether or not a person is in pain. The best way to find out if a person is in pain is to ask. A good way of asking is to say, "How bad is your pain right now on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you ever had?" Don't contradict or argue about these ratings.
- Listen for words other than "pain." Older people may use different words to describe their pain, such as "discomfort," "soreness" or "ache."
- Look for behavior or body language that could be a response to pain. The older person may be unwilling to report pain or be unable to communicate about pain in words. Behaviors to look for include facial expressions or groaning when moved.
Improve chances for obtaining good pain relief:
- Use pain medicines as prescribed. If the prescription says to take the pain medicine at certain times or at certain time intervals, do so. Do not wait until the pain comes back to give the medicine. This will cause needless suffering. There has to be a certain amount of medicine in the blood before it can reduce pain. This is why the doctor prescribes taking the medicine at regular intervals—to be sure that the blood levels stay high enough.
- Insist on good pain control. Pain tends to be undertreated. Make sure the doctor knows there is a pain problem, and let him or her know if treatment is not working or not meeting the older person's needs.
- Ask about pain clinics. If your doctor cannot control the pain, ask for a referral to a pain clinic. Universities and large hospitals often have clinics to evaluate and treat pain.
When symptoms are not an emergency but should be reported: The following symptoms should be reported during regular office hours. Call the doctor if any of the following conditions exist:
- No relief after taking pain medicine as prescribed
- Some pain relief, but there is still a lot of pain 1 or 2 days after starting the medicine
- A new type of pain, pain in new locations or new pain when moving or sitting
- Adverse side effects of pain medicines
In case of an emergency, seek medical help immediately if any of the following occur:
- Change in the ability to walk or carry out other important activities because of pain
- Changes in sleep
- Inability to cope with pain
If calling about an emergency, know these facts before you call:
- How long has the pain been a problem?
- Is it a new pain or has it happened before?
- Where is it located? Is it in more than one area? If so, which location is most bothersome?
- How severe is the pain? Ask the older person to rate the pain on a scale of 0 to 10, where 0 = no pain, 5 = moderate pain, 10 = worst ever
- Is the pain sharp and stabbing or dull and aching?
- What does the pain feel like? For example, does the pain burn or feel like an electric shock?
- Is there any numbness or tingling?
- How does the pain interfere with doing normal activities? What activities or conditions make the pain worse?
- What has been done to relieve the pain?
- What medicines are being taken? Are the medicines taken at set times or just when the person needs them? Is he or she allergic to or sensitive to any pain medicine?
Help to reduce pain:
- Use warm showers, baths, hot water bottles, or warm washcloths. Heat relaxes muscles, which can help reduce pain, and gives a sense of comfort. Do not set heating pads on high because they can burn the skin.
- Use cool cloths or ice. Cooling the skin and muscles can soothe pain, especially pain that comes from inflammation or swelling.
- Position the person carefully with pillows and soft seat cushions.
- Encourage relaxation. Breathing slowly and quietly helps the mind and body to relax and helps decrease pain. Simple relaxation methods can be learned from books or audiotapes on relaxation techniques.
- Provide pleasant activities
- Avoid stressful events when possible.
Checking on results:
Ask about pain regularly and keep notes. Adjusting pain medicines to fit each patient takes time, so change may be slow. Keep the doctor or nurse informed about changes in pain.
Source: The American Geriatrics Society Foundation for Health in Aging. Eldercare at Home, Chapter 11-Pain.