Gaps in Clinical Data, Physician Education Thwart Progress in Geriatric Pain Management

According to the Administration on Aging, patients older than 65 are expected to account for approximately 19 percent of the U.S. population by 2030, compared to 12.9 percent today. But guidelines and research on treating those patients for non-cancer pain won’t keep up with that population growth until the barriers to pharmacological pain management in older adults are removed — a topic discussed at length by the American Pain Society’s geriatric special interest group at its annual scientific meeting in New Orleans.

Data presented by Keela Herr, PhD, RN, FAAN, AGSF, co-chair of that special interest group and co-director of the John A. Hartford Center for Geriatric Nursing Excellence at the University of Iowa College of Nursing, shows a significant portion of older patients receive either no treatment or inadequate treatment for their pain across care settings. In nursing homes, 51 percent of geriatric patients with intact cognition suffer from pain, but 20 percent don’t receive treatment. The situation is worse in hospitals, where 67 percent of older patients report pain, but 51 percent aren’t treated or get inadequate care for the intensity of their symptoms. The mean pain intensity for the elderly in emergency departments is 7 out of 10, but no analgesics are ordered for 40 percent of those patients.

Herr said a number of patient, provider, and government issues prevent better pharmacologic pain management in older adults experiencing non-cancer persistent pain, and barriers such as multi-drug regimens, comorbidities, and side effects are deterring physicians from prescribing analgesics. However, Herr noted the gap in provider knowledge of geriatric pain management — including the lack of education on the benefits and risks of treatment plans — remains the greatest challenge, and with the majority of opioid studies excluding older adults as subjects, physicians are stuck with a slim amount of evidence-based analgesic treatment choices for the growing geriatric patient population.

“A cultural transformation is needed in terms of the way pain is viewed and treated, and to get there, chronic pain needs to be viewed as a disease in itself and pain needs to be recognized as a public health problem... [it's been] very difficult to get pain on the radar screen,” Herr said. “A cultural transformation is needed in terms of the way pain is viewed and treated, and to get there, chronic pain needs to be viewed as a disease in itself and pain needs to be recognized as a public health problem.”

Herr said the Institute of Medicine took a major step towards those goals when it released the “Relieving Pain in America: A Blueprint for Transforming Prevention, Care Education and Research” blueprint in 2011, though she noted its recommendations still haven’t been implemented.

Nevertheless, the NIH Pain Consortium made strides on the research side of the issue by soliciting projects for its “Leveraging Existing Data or Longitudinal Studies to Evaluate Safety and Effectiveness of Pharmacological Management of Chronic Pain in Older Adults” funding opportunity, some of which Herr said are ongoing.

“When we have new research about best practices for pain management for older adults, we need to effectively get that new information into practice quickly,” Herr said. “Looking at data that’s already collected allows us to get more information into practice more quickly, so these projects are critical for pharmacological pain management in older adults.”