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Identification of Pain-Reduction Strategies Used by Community-Dwelling Older Persons

Departments of ¹ Epidemiology and Public Health, ² Internal Medicine, ³ Neurology, ⁴ Psychiatry, and ⁵ Psychology, Yale University School of Medicine, New Haven, Connecticut.
⁶ VA Connecticut Healthcare System, West Haven, Connecticut.
⁷ Division of Geriatrics and Gerontology, Weill Medical College, Cornell University, New York.

Address correspondence to Dr. Cary Reid, Division of Geriatrics and Gerontology, Weill Cornell Medical Center, 525 East 68th Street, Box 39, New York, NY 10021. E-mail: mcr2004{at}med.cornell.edu

Background. The types of methods used by older persons to reduce chronic pain have not been adequately characterized. In this cross-sectional study of older persons with chronic nonmalignant pain, we sought to identify strategies perceived as effective in reducing pain and to ascertain factors associated with their use.

Methods. Participants included 272 community-dwelling persons aged 73 years or older. Information regarding participants' sociodemographic, clinical, psychological, and pain status was collected. Strategies perceived as effective in reducing pain were identified using a qualitative approach. Similar methods (e.g., "takes acetaminophen when necessary" and "uses Tramadol daily") were grouped into specific pain-reduction categories (e.g., analgesic medication use). Logistic regression analysis was used to identify associations between participant-related factors and the four most prevalent pain-reduction strategies.

Results. Participants had a mean (standard deviation) age of 80.9 (5.1) years and were mostly female (69%). Overall, 248 (91%) participants reported at least one effective strategy for reducing pain; the mean number of strategies per participant was 2.7 (range = 1–6). The four most prevalent pain-reduction strategies were analgesic medication use (reported by 59% of participants), activity restriction (38%), hot and/or cold modalities (28%), and exercise (23%). Although most participants reported at least one effective pain-reduction strategy, 60% rated their pain as "quite a bit" or "extremely" bothersome. In logistic regression analysis, no factor (including age and gender) was independently associated with any of the prevalent pain-reduction strategies.

Conclusions. Despite the fact that most participants perceived several pain-reduction strategies as effective, 60% reported experiencing substantial pain. Research of older persons with chronic pain is warranted to determine whether changes in the way existing pain-reduction strategies are administered can improve the management of pain or if more efficacious strategies are needed.