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Osteoarthritis: Still Painful But Different

Wednesday, April 18, 2012
Posted in Clinical Care
 

Chronic pain is very common in older adults and should not be underestimated. Prevalence figures in people over age 65 vary widely, ranging from 35% to 85%, depending on the population.  The elderly experience a number of different pain types and have a higher prevalence of pain due to aging.  Visceral/soft tissue pain, bone pain, neuropathic pain, pleuritic pain, colicky pain, and muscular pain differ in their presentation and require different management.  In 2001, the Advancing Care of Vulnerable Elders (ACOVE) expert panel recommended a quality indicator for screening elderly persons for pain because it often goes unrecognized.  Causes of chronic pain include spinal stenosis, arthritis, herpes zoster, and diabetic neuropathy. 

There are brand new guidelines available from the American College of Rheumatology specifically addressing hand, hip, and knee osteoarthritis pain.  It covers use of nonpharmacologic and pharmacologic therapies and incorporates the latest evidence (or lack thereof) for this condition.

The Institute of Medicine (IOM) published an excellent document last year reviewing many of the issues related to pain identification and management (you can find it here). The American Geriatrics Society (AGS) also has an important guideline document addressing persistent pain specifically in older adults available here.

Since multiple comorbidities and medications in older adults often coexist with acute and chronic pain, multidisciplinary team involvement, including physicians, physician assistants, nurse practitioners, pharmacists, nurses, physical therapists, case managers, and others, is likely to be the best approach.

Routine screening for pain is recommended at every visit with an older adult and many screening tools are available (see the original AGS pain guideline).  Any persistent pain affects physical function, psychosocial function, or other aspects of quality of life should be recognized as a significant problem. 


Zarit SH, Griffiths PC, Berg s. Pain perceptions of the oldest old: a longitudinal study. Gerontologist 2004; 44:459-68.

 

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