November 27, 2006 – Chronic pain is estimated to affect 30% to 75% of seniors living at home, and up to 71% of those living in long-term care facilities. However, pain remains poorly treated in the elderly.
This is what Dr David Lussier1 as part of the 12e annual conference of the Quebec Pain Society2, which brought together more than 300 doctors and health professionals in Laval.
“Unfortunately, we still know little about the pain that affects the elderly, since there are hardly any scientific studies supporting the effectiveness of potential therapeutic approaches,” says Dr.r Lussier.
According to this geriatrician, there is also little treatment for chronic pain to offer them. Hence a considerable loss of quality of life for older people. In Canada, the average number of years lived with chronic pain is estimated at 10.73.
Define pain to treat it
Chronic pain is therefore insufficiently treated in the elderly. This situation would be attributable to various factors, including the lack of resources in the health network, false beliefs on the part of the caregivers as well as certain attitudes on the part of the patients themselves.
For example, seniors sometimes use euphemisms to communicate their pain – when they communicate it! Thus, they will talk about discomfort rather than pain, which does not facilitate diagnosis and treatment.
“Some have particular attitudes and apprehensions: they keep quiet about their pain out of embarrassment, for fear of being considered disturbing or of being placed in a hospice … or even for fear of learning that they are suffering from a fatal disease, ”says Dr.r Lussier.
Geriatrician Judith Latour4 believes that health professionals have an important role to play. But, some mistakenly believe that it is more about old age itself than the pain that older people complain about. “This is often what prevents doctors from referring seniors to pain clinics,” she laments.
According to the DD Latour, we must believe the patient when he says he is in pain, “especially since osteoarthritis of the large joints is universal in the elderly”. Many also suffer from narrowing of the tendons or degeneration of the menisci and ligaments.
For a multidisciplinary approach
Finally, the health system does little to encourage the emergence of a multidisciplinary approach which, according to Dr.r Lussier, is clearly more beneficial for the patient’s quality of life.
In this type of approach, several health professionals can revolve around the patient and his family: doctor, nurse, physiotherapist, occupational therapist, psychologist, pharmacist, dietitian, social worker, priest …
Many long-term care hospitals (CHSLDs) opt for such an approach. But, according to Dr Lussier, the means are lacking for them to offer a fully adequate service. And he is sorry: “Prescribing drugs is the easiest thing for a doctor … A multidisciplinary approach would give better access to non-pharmacological treatments, such as physiotherapy or psychotherapy, this which would be even more beneficial for patients. “
Martin LaSalle – PasseportSanté.net
1. The Dr David Lussier is a geriatrician at the McGill University Health Center (MUHC) and at the University Institute of Geriatrics of Montreal. He is also assistant professor of geriatrics at McGill University and the University of Montreal.
2. To find out more about the Quebec Pain Society: www.sqd.ca [consulté le 22 novembre 2006].
3. Moulin DE, Clark AJ, et al. Chronic pain in Canada-prevalence, treatment, impact and the role of opioid analgesia, Pain Research & Management, winter 2002, vol. 7, no 4, 179-84.
4. The DD Judith Latour is a geriatrician at the Center hospitalier de l’Université de Montréal (CHUM) and associate clinical professor at the University of Montreal.
