Open AccessINADEQUATE PAIN CARE FOR ELDERS: THE NEED FOR A PRIMARY CARE–PAIN MEDICINE COMMUNITY COLLABORATION
Author(s) -
Rollin M. Gallagher,
Jana Mossey
Publication year - 2002
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1046/j.1526-4637.2002.202419.x
Subject(s) - medicine , primary care , pain management , pain medicine , health care , alternative medicine , physical therapy , nursing , family medicine , psychiatry , pathology , anesthesiology , economic growth , economics
Rollin M. Gallagher, MD, MPH and Jana Mossey, PhD, MSN, MCP Hahnemann University Introduction: We conducted a 24 month longitudinal study of elderly with excellent healthcare access to investigate the myth that pain is an inevitable consequence of growing older, diminishing the importance of its treatment. Methods: Psychosocial and physical functioning, illness level and pain (adaptation of the McGill Pain Questionnaire) were measured in 232 older retirement community residents at 5 consecutive 6 month intervals. 185 who completed at least 4 assessments were classified as: “no pain”; “pain without activity limitations”, or “pain with activity limitations”. Results: Only 2 (1.08%) denied pain at all assessments; conversely, 150 (64.7%) reported pain, with or without activity limitations, at each assessment. 67 (36%) were considered in the Chronic Pain (CP) group (CPG) by reporting pain at each assessment and indicating at 3 or more assessments that pain limited activities. The CPG did not differ from those without CP in age, gender, schooling, marital status, social support and social adjustment. CP individuals reported more medical conditions, poorer physical function, and more depression. Although>80% of the CPG reported regular pain medication use, 65–75% described pain at its worst as “quite” to “extremely” bothersome at each assessment, and 25–48% said pain limited activities “quite a bit” or “extremely”—all these figures indicate ineffective treatment. 42 (78%) reported pain at the same 2 or more sites at every assessment. Discussion: The high prevalence (36%) of activity‐limiting CP in elderly with excellent access to healthcare is likely conservative compared to rates in less affluent elderly. Several approaches appear promising. CP patients typically make more physician visits—in our study, the CPG reported 1.33 times more. PCP gatekeepers can effectively manage a large proportion of the elderly in pain but must be supported by pain medicine and community rehabilitation services with appropriate access, education, mentoring programs.