"The thing about chronic pain," one of our clients said to us, " is that you can never forget about it. It is with you all the time, twenty four hours a day." Pain is the most common complaint of older people; up to one in five older people are taking pain medication.
Chronic pain can be very difficult to understand if you have never endured it. It does more than hurt. Chronic pain can make people feel hopeless about their lives and future. It interferes with the ability to find any joy in daily life. Dealing with chronic pain can be exhausting. Physical exhaustion comes from the way people cope with the pain--muscles are often tensed all over the body and there is an energy use by the body as it deals with the stress. Psychological exhaustion results from the 24/7 efforts to cope with pain. Pain can interfere with both sleeping and eating. Sufferers can become run down. impairing their immune systems. The hopelessness, exhaustion, and being run down frequently leads to major depression.
Chronic pain often becomes a factor in the dynamics of relationships.People suffering from pain may have low tolerance for frustration. They can become easily angered and irritated. People they love and caregivers can be pushed away.
Pain can become a third party in relationships. Caregivers who are dealing with someone who has chronic pain often feel helpless. After a while, that helplessness can turn to discouragement and frustration. This can be a precursor to caregiver burnout. With no safe and appropriate place to vent it, the caregiver may end up focussing their feelings on the person for whom they are caring. They may become abusive, or they can give up, and either psychologically or literally, remove themselves from the relationship.
Pain, especially chronic pain, in older people is often neglected or inadequately treated. This is due to several factors. Sometimes there is an attitude or expectation on the part of the older person, caregivers, or professionals, that old age is always accompanied by pain. Too frequently there is the assumption that nothing can be done. Sometimes pain is not reported--the older person doesn't want to bother anyone, they are afraid of what the pain or the treatment would mean, or they believe they have to "tough it out." Sometimes people do report pain but they are not believed; or the degree of pain is not validated. Caregivers may believe that the reporting of pain has a manipulative component-- "he just wants attention." Staff in nursing homes may not recognize symptoms of pain, or may not have the training to apply proper intervention.
It should be particularly noted that people with dementia are often unable to directly report pain. They may "act it out" through anger, hostility, depression, withdrawal, or not eating. As a result, it is often that the symptoms are treated instead of the pain that is causing them. .
The sad and frightening result of the inability to report pain has been documented in research. It showed that a significant number of people with dementia received less treatment for (probable) severe pain than cognitively intact older people.
Knowledge about pain and approaches to pain treatment is much more advanced than it was even ten years ago. Approaches range from use of aspirin or ibuprofen to morphine, heroin, and other opiates. The use of opioids in the treatment of chronic and severe pain generally does not result in addictions. Often, anti-depressants and anti-convulsants are used as part of treatment. Complementary treatments include massage, yoga, TENS, meditation, and other psychological approaches.Treatment needs to be tailored to the individual, as well as to the condition. It may take quite a while to "get it right."
