Not so, say recently published guidelines on managing persistent pain from the American Geriatrics Society.

Pain not normal
"Pain is not a normal part of ageing," Dr Paul Katz, a geriatric specialist from the University of Rochester, explained at the society's recent annual scientific meeting in Washington, "It is imminently treatable."

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The guidelines were first developed in 1998 to help ensure that older people received effective pain management that would let them maintain their dignity and overall quality of life.

The need for the guidelines came about because concern about causing addiction to pain medication sometimes leads doctors to treat pain less aggressively, and many patients are unaware there are effective treatments available, reports the foundation.

"Everyone was afraid to treat older people because of the concern that older people were getting too much medication, like Valium and other tranquillisers," says Dr Michael Freedman, director of the division of geriatrics at New York University Medical Centre. "So, then everybody stopped treating pain, and patients were left in terrible pain."

However, he adds, there are many new pain medications and some have fewer side effects. Also, he says, physicians have learned they can give elderly patients narcotics for their pain without causing addiction.

The guidelines
The guidelines were updated this year to include the newer medications and more recent evidence from medical studies.

Some of the most important guidelines include:

• All older patients should be asked if they are in pain. If they have pain, doctors need to take the time to accurately assess the pain.
• For people who are cognitively impaired, like Alzheimer's patients, doctors should interview their caregivers about any possible pain the patient might be feeling.
• Treatment should be as simple as possible.
• Placebos should never be given to patients.
• Acetaminophen should generally be the first drug tried for pain.
• Over-the-counter, non-steroidal anti-inflammatories should be avoided for people who need long-term therapy, in favour of prescription anti-inflammatory medications, which appear to have fewer adverse side effects.
• Patient and caregiver education in pain management is essential.
• Exercise should be encouraged to increase flexibility and strength.

"When a patient comes in with pain, the most important thing to do is relieve the pain," Freedman says. "Pain is terrible. Think about when you get a headache, you can't do anything."

Visit Health24's Pain Centre

Links:
Arthritis Foundation of South Africa
Multiple Sclerosis South Africa
The South African Society of Physiotherapy

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