The prevalence of persistent pain is high in older adults, and undertreated pain is disproportionately elevated in older adults with neurocognitive disorders (NCDs). This chapter will explore the concept of pain and how it may be expressed differently in an individual suffering from an NCD.
The expression of pain commonly occurs in the context of behavior as communication. Therefore, the main focus of this chapter is the behavioral expression of pain, as well as the physiological consequences of undertreated pain. Attention will be given to the assessment of pain in individuals with NCDs, as well as barriers to adequate treatment, including generational difference and ethnic disparities. Pharmacological and nonpharmacological treatment recommendations are included.
Persistent pain Barriers to pain Ethnic and racial disparities Sequelae of undertreated pain Assessment PAINAD Pharmacological interventions Nonpharmacological interventions AGS guidelines
This is a preview of subscription content, log in to check access.
Apinis C, Tousignant M, Arcand M, Tousignant LY. Can adding a standardized observational tool to interdisciplinary evaluation enhance the detection of pain in older adults with cognitive impairments? Pain Med. 2014;15(1):32–41.Google Scholar
Beach PA, Huck JT, Miranda MM, Bozoki AC. Autonomic, behavioral, and subjective pain responses in Alzheimer’s disease. Pain Med. 2015;16(10):1930–42.CrossRefGoogle Scholar
Atkinson TJ, Fudin J, Pandula A, Mirza M. Medication pain management in the elderly: unique and underutilized analgesic treatment options. Clin Ther. 2013;35(11):1669–89.CrossRefGoogle Scholar
Bruckenthal P, D’Arcy YM. Assessment and management of pain in older adults: a review of the basics. Top Adv Pract Nurs. 2007;7(1).Google Scholar
DeWaters T, Faut-Callahan M, McCann JJ, Paice JA, Fogg L, Hollinger-Smith L, et al. Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery. Orthop Nurs. 2008;27(1):21–8.CrossRefGoogle Scholar
Egan M, Cornally N. Identifying barriers to pain management in long term care. Nurs Older People. 2013;25(7):25–31.CrossRefGoogle Scholar
Ferrell BA, Fine PG, Herr KA: 2010. Strategies for success: pharmacologic management of pain in the older adult. Monthly Prescribing Reference; Supplement (October): 1–14. Table 3, pg. 10.Google Scholar
Fine M. Quantifying the impact of NSAID-associated adverse events. Am J Manag Care. 2013;19(14):S267–72.PubMedGoogle Scholar
Franceschi M, Scarcelli C, Niro V, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf. 2008;31:545.CrossRefGoogle Scholar
Gebhart GF. Scientific issues of pain and distress. In: National Research Council (US) committee on regulatory issues in animal care and use. Definition of pain and distress and reporting requirements for laboratory animals: proceedings of the workshop held June 22, 2000. Washington, D.C: National Academies Press (US); 2000.Google Scholar
Gibson SJ. Pain and aging: a comparison of the pain experience over the adult life span. In: Dostrovsky JO, Carr DB, Koltzenburg M, editors. Proceedings of the 10th world congress on pain. Progress in pain research and management, vol. 24. Seattle: IASP Press; 2003. p. 767–90.Google Scholar
Harrison JM, Lagisetty P, Sites BD, Cuo C, Davis MA. Trends in prescription pain medication use by race/ethnicity among US adults with noncancer pain, 2000–2015. Am J Public Health. 2018; https://doi.org/10.2105/AJPH.2018.304349.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain. Arthritis Care Res. 2011;63(S11):S240–52.CrossRefGoogle Scholar
Herr K, Coyne PJ, Key T, et al. Pain assessment in the nonverbal patient: position statement with clinical practice recommendations. Pain Manag Nurs. 2006;7(2):44–52.CrossRefGoogle Scholar
Holmquist GL. Opioid metabolism and effects of cytochrome P450. Pain Med. 2009;10(suppl_1, 1):S20–9.CrossRefGoogle Scholar
Horgas A, Miller L. Pain assessment in people with dementia. Am J Nurs. 2008;108(7):62–71.CrossRefGoogle Scholar
JAGS. Pharmacological management of persistent pain in older persons. Pain Med 2009;57:1331–46; J Am Geriatr Soc 10(6):1062–83.Google Scholar
Jastrzab G, Kerr S, Fairbrother G. Misinterpretation of the faces pain scale-revised in adult clinical practice. Acute Pain. 2009;11(2):51–5.CrossRefGoogle Scholar
Kaasalainen S. Pain assessment in older adults with dementia: using behavioural observation methods in clinical practice. J Gerontol Nurs. 2007;33(6):6–10.PubMedGoogle Scholar
Nygaard HA, Jarland M. Are nursing home patients with dementia diagnosis at increased risk for inadequate pain treatment? Int J Geriat Psychiatry. 2005;20:730–7.CrossRefGoogle Scholar
Porter FL, Malhotra KM, Wolf CM, et al. Dementia and response to pain in the elderly. Pain. 1996;68:413–21.CrossRefGoogle Scholar
Reynolds KS, Hanson LC, DeVellis RF, Henderson M, Steinhauser KE. Disparities in pain management between cognitively intact and cognitively impaired nursing home residents. J Pain Symptom Manage. 2008;35(4):388–96.CrossRefGoogle Scholar
Richy F, Bruyere O, Ethgen O, et al. Time dependent risk of gastrointestinal complications induced by nonsteroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach. Ann Rheum Dis. 2004;63:759–66.CrossRefGoogle Scholar
Robinson S, Vollmer C. Undermedication for pain and precipitation of delirium. Medsurg Nurs. 2010;19(2):79–83.PubMedGoogle Scholar
Rose SS. Delirium. In: Mauk K, editor. Gerontological competencies for care. 4th ed. Burlington: Jones & Bartlett; 2018.Google Scholar
Rostad HM, Utne I, Grov EK, Smastuen MC, Puts M, Halvorsrud L. The impact of pain assessment intervention on pain score and analgesic use in older nursing home residents with severe dementia: a cluster randomized controlled trial. Int J Nurs Stud. 2018;84:52–60.CrossRefGoogle Scholar
Van Iersel T, Timmerman D, Mullie A. Introduction of a pain scale for palliative care patients with cognitive impairment. Int J Palliat Nurs. 2006;12(2):54–9.CrossRefGoogle Scholar
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9–15.CrossRefGoogle Scholar
Zwakhalen SMG, Hamers JPH, Berger MPF. The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain. 2006;126(1–3):210–20.CrossRefGoogle Scholar