Doctors urged to do more to control seniors' pain

Geriatric care guidelines recommend starting with acetaminophen and moving on to COX-2 inhibitors and opioids.

By Susan J. Landers, AMNews staff. June 3, 2002.

Washington -- Physicians can do much to end the persistent pain that plagues many older people. That is the message of new guidelines from the American Geriatrics Society.

The recommendations, announced at the AGS' annual meeting last month in Washington, D.C., reflect advances in pain assessment and treatment made since guidelines were last issued four years ago.

"We wanted to make them more clinically relevant," said Bruce Ferrell, MD, chair of the panel that drafted the guidelines and an associate professor in the geriatrics division at the University of California, Los Angeles, School of Medicine.

Pain is a common complaint among older patients. A Louis Harris telephone survey found that one in five older Americans is taking analgesics several times a week or more, and 63% of those had taken prescription pain meds for more than six months.

Yet most experts believe that pain is undertreated, often because physicians and other practitioners don't recognize it in their patients.

Panelist Paul Katz, MD, professor of medicine at the University of Rochester School of Medicine and Dentistry, pointed to a recent study that found 25% of cancer patients in nursing homes were not provided any needed analgesic.

"So the fact is we do need guidelines," he said. "We're not doing the job."

Another reason for the prevalence of pain in the elderly is that many older people believe that it is simply a natural part of aging, said Keela Herr, PhD, RN, who also served on the panel. Elderly patients must be convinced otherwise, she said. [...]