Health and Wellness for Older People: Best Practices in Pain Management

Chronic pain is a widespread problem for individuals in what oftentimes is called their Golden Years. Without sounding trite, the candid reality is that chronic pain can make the latter years of a person’s life far from golden. 

Through this article, we discuss a number of issues associated with health and wellness for older individuals and developments in regard to the best practices on pain management. We begin by discussing the definition of chronic pain.

Definition of Chronic Pain

Chronic pain is defined as pain that is persistent beyond the usual course of a disease or injury. In other words, chronic pain is described as pain that lasts longer than a minimum of a three to six month period of time. 

As an aside, some pain management experts are now recommending the use of the term persistent pain rather than chronic pain. The rationale behind this is that these experts maintain that the term persistent pain “evokes a more positive description of this condition.”

Chronic Pain and Older People

Chronic pain is described as being a wide-spread and significant problem among older people. A significant percentage of older individuals have diseases that usually are accompanied by chronic pain. These include:

  • Arthritis
  • Diabetes

Arthritis is considered to be the most common cause of persistent pain among older Americans. A stunning 49 to 59 percent of all older individuals in the U.S.A. are afflicted with some form of arthritis and its associated chronic pain. 

Diabetes is another disease afflicting a significant segment of the U.S. population. Diabetes can result in many older individuals experiencing chronic or persistent pain the extremities.

Functional Consequences of Chronic Pain

An older individual can face a number of different functional consequences associated with chronic pain. The four most commonplace of the consequences are:

  • Problems with walking and mobility
  • Decline in overall functional capabilities or abilities
  • Psychosocial problems, including:
    • Sleep disturbances
    • Depression
    • Anxiety
    • Fatigue
  • Increased risk of disability and loss of independence

Pain Management Best Practices: Heath and Human Services Interagency Task Force Report

The U.S. Department of Health and Human Services issued what is entitled the Pain Management Practices Interagency Task Force Report. This comprehensive report establishes a series of parameters that must be satisfied in order to achieve what it terms as “excellence” in chronic pain case. These parameters are:

  • An understanding that a primary emphasis on an individualized and patient-centered approach for diagnosis and treatment of pain is essential to establish a therapeutic alliance between patient and clinician.
  • Acute pain can be caused by a variety of different conditions that include trauma, burn, musculoskeletal injury, neural injury, as well as pain due to surgery, procedures, and treatments. A multi-modal approach that includes medications, nerve blocks, physical therapy, and other modalities should be considered for acute pain conditions.
  • A multidisciplinary approach for chronic pain across various disciplines, utilizing one or more treatment modalities, is encouraged when clinically indicated to improve outcomes. These include the five broad treatment categories. Each of these broad treatment categories is discussed in greater detail in a moment in this article. 

Best Practices in 21st Century Pain Management: Five Broad Treatment Categories

As mentioned, there are deemed to be five broad chronic pain treatment categories. These are:

  • Medications
  • Restorative therapies
  • Interventional approaches
  • Behavioral health approaches
  • Complementary and integrative health

Medications

As a result of the opioid crisis, the utilization of medications for pain management has been under intense scrutiny. With this in mind, the Department of Health and Human Services reached this conclusion in regard to pain management best practices and the use of medications or pharmaceuticals: Various classes of medications, including non-opioids and opioids, should be considered for use. The choice of medication should be based on the pain diagnosis, the mechanisms of pain, and related co-morbidities following a thorough history, physical exam, other relevant diagnostic procedures and a risk and benefit assessment that demonstrates the benefits of a medication outweighs the risks. The goal is to limit adverse outcomes while ensuring that patients have access to medication-based treatment that can enable a better quality of life and function.

Restorative Therapies

Restorative therapies are part of the comprehensive best practices in pain management. Restorative therapies include those of physical therapists and occupational therapists.

Interventional Approaches

The best practices in pain management can call for the use of interventional approaches, when clinically indicated. Interventional approaches are described as those that include image-guided and minimally invasive procedures available as diagnostic and therapeutic treatment modalities for acute, acute and chronic, and chronic pain when clinically indicated.

  • Examples of interventional approaches include: 
  • Trigger point injections
  • Radiofrequency ablation
  • Cryoneuroablation
  • Neuromodulation

Behavioral Health Approaches

According to the Department of Health and Human Services report, the best pain management practices include a behavioral health component as well. The behavioral health component is designed to address a variety of aspects of pain that can have a significant impact on treatment options. These aspects addressed behavioral health approaches include:

  • Psychological
  • Cognitive
  • Emotional
  • Behavioral
  • Social 

Complementary and Integrative Health

The best practices in pain management at this juncture of the 21st century truly is comprehensive. They call for the inclusion of complementary and integrative health practices that include such elements as:

  • Acupuncture
  • Massage
  • Movement therapies (tai chi, yoga)
  • Spirituality
  • Other practices (that may be clinically indicated)

Best Pain Management Practices and Multidisciplinary Management

In conclusion, when it comes to the best practices in pain management, a multidisciplinary approach is needed. According to experts in the field, “effective multidisciplinary management of the potentially complex aspects of acute and chronic pain should be based on a biopsychosocial model of care.”