Living With Chronic Pain and Care for Elderly
Last Updated: April 4, 2013
Diane Slomkowski knows about living with chronic pain. For
years, she has suffered from fibromyalgia. Then her husband was
colon cancer, and her own illness receded to the background as
she became his caretaker.
"I have to take care of him now," says Slomkowski, 64, who lives
in Toledo, Ohio. "It's actually made me realize what it was like
for him to take care of me all those years."
Ronald Slomkowski, 67, was first diagnosed with colon cancer
three years ago. A year later, doctors reported the cancer had
spread to his lungs. In the meantime, he's undergoing constant
chemotherapy. Although chemotherapy in itself no longer directly
causes pain other than nausea, it regularly aggravates his
lower-back arthritis, and triggers pain in his hands and feet,
according to his wife Diane.
Up to 50% of older adults living at home, and between 45 and 80%
of those living in nursing homes,
have significant pain that is often persistent, according to an
American Geriatrics Association report. If not treated effectively,
chronic pain can become a debilitating condition, especially in
older persons. Constant struggling with physical pain can cause
depression, anxiety, social problems, loss of appetite and sleep.
In contrast to acute pain, which is a temporary sensation following
an event such as surgery, chronic pain lasts 3-6 months or longer,
often causing additional physical or psychological problems because
of its duration.
The Slomkowskis have been living with chronic pain for years.
Some days, Ronald will let his wife know when his pain levels are
high. Other days, he keeps it to himself. Those are the hardest,
"You can just read it by his actions-he will just sit there and
stare off into space and I know something is bothering him," Diane
says. "He doesn't want to share because he doesn't want to burden
me, but I would rather know because not knowing is worse. I sit
there and wonder, what's going on now? Is he thinking about dying,
or is he in pain and it hurts too much to talk about it?"
Then there are the times when Diane takes one look at her
husband and heads for the medicine cabinet. "When he looks at me
and he's about to cry, I say go ahead, take the OxyContin," she
says. OxyContin®, a strong narcotic, has become a last
resort, because it causes bowel obstruction in her husband.
Yet although chronic pain has made itself an unwelcome,
all-too-familiar guest in the lives of the Slomkowskis, they refuse
to give it the final word. In the midst of illness, of
chemotherapy, of medication, they make the time to take pleasure in
"We have a camper and we go out to the camp ground. We sit on
the swing. We take walks with the dog," says Diane, who got a puppy
after her husband was forced into retirement because of the cancer.
The puppy "brings us much laughter. She does her funny things and
it takes our minds off of pain problems." The couple also goes out
to eat and to watch movies-but earlier than most, catching matinees
and early dinners, so they avoid the crowds and find the space and
quiet they need to have an enjoyable experience.
And there's nothing like a good madcap comedy on television. "We
like that Tim Allen movie,The Shaggy Dog. It doesn't take much to
amuse us these days," laughs Diane.
Diane knows she also needs to take care of herself, both
physically and emotionally. Because of her fibromyalgia, it is
particularly important for her to balance both the needs of her own
illness and that of her husband's. "If I let myself go too much,
I'm down," she says.
A job in the gift shop of a local hospital, she finds,
re-energizes her. Socializing with others and focusing on her work
takes the attention away from her pain and gives her the energy she
needs to go back home and take care of her husband. "When I come
back home, I am upbeat and I need that so I can give him what he
needs," says Diane.
Staying active is one of the most effective ways to make living
with chronic pain a more tolerable experience, according to Dr.
Wayne McCormick, associate professor and section chief of the
Division of Gerontology and Geriatric Medicine at the University of
Washington. Although it may seem counter-intuitive when someone is
experiencing pain, McCormick says clinical trials have proven that
being active is valuable for the very reasons the Slomkowskis found
it beneficial-it takes the person's mind off their pain.
"We try to make people continue to be active because when people
have pain they tend to focus on it more," says McCormick. "There
have been trials on whether it is best to keep people at rest or
moving about with pain. The best is keeping active."
Chronic pain in the elderly may be caused by a number of
factors. It may be triggered by a physical incident, such as a
sprained back or a serious infection. Persistent pain may also be
linked to an ongoing condition such as
cancer, shingles, circulatory problems, and muscular conditions
such as fibromyalgia and myofascial pain. Other common chronic pain
complaints include neurogenic pain (resulting from damage to nerves
or the central nervous system itself) and psychogenic pain (pain
that is not due physical injury or disease).
McCormick reports arthritis pain is the most common complaint he
sees in his patients, who are typically about 80 years old. "It can
be the most severe," he says. "Sometimes women have fractures in
the spinal column or elsewhere and that is uniquely painful."
Seniors often think that chronic pain is a natural part of
growing old, and that they have to put up with it. This is a common
misperception that can lead to depression, worsening of the pain,
and other health-related problems.
There are, in fact, many treatment methods that can effectively
reduce the pain and help make it bearable. In addition to lifestyle
choices such as staying active, treatments run the gamut from
physical therapy to strong medication.
The World Health Organization has established a three-step pain
ladder for treatment of chronic pain which starts with simple,
over-the-counter medications like acetaminophen
(Tylenol®), according to McCormick. Also on this first
level of pain management are the anti-inflammatory drugs (NSAIDs),
including aspirin, ibuprofen, and naproxen. While not
habit-forming, any prolonged use of NSAIDs needs to be under a
doctor's supervision, as they may produce side effects such as
stomach irritation and kidney problems. Within recent years, newer
prescription NSAIDs called COX-2 inhibitors have become available
that have fewer gastrointestinal side effects but may increase the
risks of some other, potentially more serious side effects.
Also commonly prescribed at this less-intensive level of pain
treatment are ice packs and exercise. Topical drug treatments, such
as lidocaine patches, can be used to ease pain in some conditions,
as can TENS (transcutaneous electrical nerve stimulation) and
If these treatments don't help significantly ease the pain, the
next step is to add an opioid such as Percocet®
(acetaminophen with oxycodone) or Vicodin®
(hydrocodone). Stronger opioids such as OxyContin® (a
sustained release oxycodone) or morphine for moderate to severe
pain represent the final step on the pain ladder.
McCormick says he doesn't hesitate to prescribe the stronger
medications if they appear to be the only way of easing the
patient's pain, despite the risks of some unpleasant side effects
like constipation, nausea, vomiting, thought and memory impairment,
There is also the question of whether patients will become
addicted to the opioids because of their narcotic effects. While
the chances for addiction by persons suffering acute pain are low,
there are several schools of thought about long-term use of opioid
pain medication, according to the American Chronic Pain Association
report. Arguments for using these stronger opioids stress the
importance of patients' relief from pain, even if that means using
opioids for long periods of time. Additionally, many experts such
as a panel at the American Geriatrics Society assert that addiction
to opioid pain medicines is very rare in older adults. Other
medical professionals counter that the side effects, functional
impairment, and the threat of addiction linked to opioids means
there is no real benefit in taking them.
The American Pain Society and the American Academy of Pain
Medicine have issued a joint consensus statement supporting the
cautious use of chronic opioid medication for some patients. This
entails careful examination by and follow-up with a physician, as
well as a thorough discussion of the risks and benefits with the
Alternative methods such as chiropractors, acupuncture, and
naturopathic medicine have also proven to be effective in treating
chronic pain, McCormick says. Some patients even turn to hypnosis
or imaging therapy, he says: "This has to do with the power of the
mind and thinking about other thoughts, concentrating on
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One of the most challenging aspects for those who care for
elderly people living with chronic pain is finding ways to talk
about the pain itself. Many seniors are uncomfortable discussing
their pain, while others may find it hard to describe it.
Yet pain communication is a key element of successful care for
elderly patients living with chronic pain, especially when an
aspect of their pain becomes intolerable and needs to be addressed.
If a person is reluctant to tell their caregiver about their pain,
one of the best ways to gain an understanding of their condition is
simply to ask, says McCormick. "All we can do is give people
permission to report their symptoms by continuing to ask."
In addition, caregivers can learn to read when their loved one
is unwilling or unable to communicate their pain verbally.
According to an American Geriatrics Society report, signs to look
- Eyes that are closed tightly
- Knitted eyebrows
- Wrinkled forehead (grimacing)
- Groaning when moved
- Clenched fists
- A stiffened upper or lower body that is held rigidly and moved
- Decreased activity level
- Trouble sleeping
- Poor appetite
It can also be helpful to debrief the loved one before a call or
visit to the doctor's office. This includes obtaining information
about the duration of the pain, whether it is a new pain or
recurring pain, its location, severity, and which activities are
affected by it. It is also helpful to know what medications are
being taken, and what medications the person is sensitive to.
A doctor should be called immediately if:
- There is a sudden change in the ability to walk or carry out
other important activities because of pain.
- There is a new pain that is severe.
- There is a new pain that is not severe, but causing the person
- There is talk about not wanting to live anymore.
Do not hesitate to call a doctor for less urgent reasons as
well, such as complaints about the ineffectiveness of pain
medication, new or different pain, adverse side effects of pain
medications, changes in sleep, and difficulty coping with pain.
While communication is essential for addressing critical
episodes, it is just as important on a day-to-day basis.
Establishing a safe way to talk about pain between loved ones helps
keep relationships open and avoids misunderstandings. "Don't shut
people out, let them know," Diane Slomkowski says. "Don't complain,
just say, okay, I'm having a bad day now, let's work around it.
Take care of yourself but don't let it be something you focus on
all the time; life is too short."