One of the most unpleasant aspects of many chronic diseases is pain. Pain is disruptive, saps energy, negatively affects quality of life, and can lead to an ever-intensifying cycle of pain, anxiety, and anguish.

Pain is also one of the most common complaints of older adults, and does not necessarily reflect the same things as pain in younger adults; for older adults it not only is an indication that something is wrong, but also can be responsible for depres­sion, sleep disorders, decreased social interaction, impaired mobility, and increased health care costs (Karp et al., 2008).

Unfortunately, many myths exist about pain in older adults, such as that older adults should simply accept the physical pain they experience as part of growing older. Failure to understand the real nature of pain in older adults can lead to a failure to relieve it.

How do people manage pain? Perhaps the most important step is to understand that pain is not a necessary part of treatment, people can control their pain, no one approach is likely to be suffi­cient, and asking for pain relief is to be expected. There are two general pain management techniques: pharmacological and nonpharmacological (Karmol,

2008) . These approaches often are used together for maximum pain relief. Pharmacological approaches to pain management include nonnarcotic and narcotic medications. Nonnarcotic medications are best for mild to moderate pain, whereas narcotic medications are best for severe pain. Nonnarcotic medications include NSAIDs, such as ibuprofen and acetamino­phen. However, these drugs must be used with cau­tion because they may cause toxic side effects in older adults. Narcotic drugs that work well in older adults include morphine and codeine; other commonly used drugs, such as meperidine and pentazocine, should be avoided because of age-related changes in metabo­lism. Patients taking any of these medications must be monitored very closely. Nonpharmacological pain

control includes a variety of approaches, all of which are effective with some people; the trick is to keep trying until the best approach is found. Common techniques include the following:

• Deep and superficial stimulation of the skin through therapeutic touch, massage, vibration, heat, cold, and various ointments

• Electrical stimulation over the pain site or to the spine

• Acupuncture and acupressure

• Biofeedback, in which a person learns to control and change the body processes responsible for the pain

• Distraction techniques such as soft music that draw a person’s attention away from the pain

• Relaxation, meditation, and imagery approaches that rid the mind of tension and anxiety

• Hypnosis, either self-induced or induced by another person

Like other treatments, nonpharmacological interventions have both advantages and disadvan­tages. The best approach is to try various techniques until the best relief is obtained.

The most important point is that pain is not a necessary part of growing old or having a disease. Pain relief is an important part of recovery and should be included in any treatment regimen for adults of all ages.

Concept Checks

1. What are the most important things to consider in chronic diseases?

2. What are some of the most common chronic conditions in older adults?

3. How is pain managed?