Presented at the 2013 AAPM Annual Meeting « Back

Older and Better: Parallels Between Successful Aging and Pain Treatment

Mitchell J. Cohen, MD, mitchell.cohen@jefferson.edu¹, Dilip V. Jeste, MD², (1) Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, (2) University of California, San Diego, La Jolla, California

Introduction: At least 1 in 3 patients over age 65 report ongoing significant pain, often inadequately treated.1 2 Chronic pain and aging are both culturally feared and provoke clinician pessimism. Contemporary geriatric epidemiology and constructs of “successful aging” can inform improved geriatric pain care. Materials and Methods: Literature Review. Results: Research on the concept of “successful aging” and accrued epidemiologic data highlight central intuitive and non-intuitive issues in geriatric pain care: 1. Emotional adjustment often improves after middle age across cultures, even as physical health decreases, due in part to aging brain changes that may improve emotional regulation; 2. Cultural biases, not longitudinal data, foster clinician pessimism regarding treatment outcomes; 3. Pain prevalence does not relentlessly progress, peaking at age 65 then decreasing; 4. Adjustment to chronic pain and aging can be independent of objective disease and symptom levels; 5. Relative scarcity of effective pharmacologic/interventional pain treatments does not preclude potential to improve quality of life; and, 5. Overlapping pain treatment and aging literatures identify factors positively affecting both processes (Figure 1), including treatment of depression, physical exercise, healthy weight, social engagement, ongoing learning/problem-solving, and community involvement. Optimism, resilience, and acceptance foster successful adaptation to aging and pain; interventions bolstering these can reduce suffering (Table 1) as shown in the case and comprehensive treatment plan presented (Boxes 1 and 2). Conclusions: Aging research and principles of "successful aging" can offset clinician ageism and help physicians improve breadth and efficacy of treatment plans for geriatric patients with chronic pain. References: 1) Helme, R. D. & Gibson, S. J. The epidemiology of pain in elderly people. Clinics in geriatric medicine 17, 417–31, v (2001). 2) Blazer, D. G., Ph, D. & Browning, R. Successful Aging. 2–5 (2006). 3) Viane, I., Crombez, G., Eccleston, C., Devulder, J. & De Corte, W. Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities. Pain 112, 282–8 (2004). 4) Depp, C. A. & Jeste, D. V. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. The American journal of geriatric psychiatry?: official journal of the American Association for Geriatric Psychiatry 14, 6. 5) McCracken, L. M. & Eccleston, C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain 118, 164–9 (2005). 6) Eccleston, C. & Crombez, G. Worry and chronic pain: a misdirected problem solving model. Pain 132, 233–6 (2007). 7) Van Damme, S., Crombez, G. & Eccleston, C. Coping with pain: a motivational perspective. Pain 139, 1–4 (2008). 8) Bernabei, R. et al. Management of Pain in Elderly Patients With Cancer. 279, (1998).

Funding: None