Pain Management in the Elderly

Too Many Seniors Suffer Needlessly from Untreated Pain

Senior citizens are undertreated for pain far more often than younger patients. According to various studies, 40% to 80% of elderly nursing home residents suffer needlessly due to inadequate pain treatment (Roberto Bernabei, MD et al., JAMA 1998; 279(23); Cancer Pain Release, World Health Organization; Facts on Dying, Brown University).

Pain in elderly patients is not always assessed properly, and may be underreported (see Diagnosing and Treating Pain). Too frequently, elderly patients do not report their pain because they fear retaliation, the possibility of addiction, or loss of respect. They may be stoical or believe that pain is a natural part of aging.

Some health care professionals erroneously believe that the elderly are less sensitive to pain, or give weak doses of pain medications for fear that older patients will not tolerate opioids. They may equate pain management with addiction and fear problems with the state Medical Board (Sopie Colleau, Cancer Pain Release Vol.13, No. 2 (2000)).

Monitoring the use of analgesics and other pain medication is time consuming. In nursing homes, pain management may be limited if staffing is inadequate. Also, some nursing homes are unwilling to stock restricted drugs that may be useful in the treatment of pain.

Legal Aspects of Undermedication

Several state Medical Boards have issued special guidelines about the treatment of pain. The California Medical Board specifies conditions under which a physician may prescribe pain medication without undue interference from regulatory agencies. Medical boards in Florida, North Carolina, and Washington have adopted similar policies. The Washington law states “practitioners...need not fear disciplinary action from the commission for prescribing, dispensing, or administering opiods when treating pain so long as the care provided is consistent with currently acceptable medical practices. This includes acute, chronic and intractable pain”(WAC 246–919–800).

Ten states have laws that deal specifically with pain management (David Joranson, Aaron Gilson; APS Bulletin, 7(2):7–9). In California, for example, the Pain Patient’s Bill of Rights (Health and Safety Code §§124960–124961) gives patients the right to request or reject the use of pain medications. It declares that patients suffering from severe chronic pain should be provided with proper treatment, including opiates, if appropriate.

Undertreating the pain of an elderly patient has been considered a form of elder abuse. See Undermedication as Elder Abuse for details.

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