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Orthopaedic Essentials: Research Update

Barriers to managing chronic pain of older adults with arthritis.

Schoen, Delores C.

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Barriers to managing chronic pain of older adults with arthritis.

Davis, G. C., Hiemenz, M. L., & White, T. L. (2002). Image: Journal of Nursing Scholarship, 34(2), 121–126.

Mobily, Herr, Clark, & Wallace (1994) estimated that 70% of older adults experience chronic pain. The pain is usually due to arthritis and neuralgia, with osteoarthritis being the most common chronic condition among those aged 65 yewars and over. The pain often limits basic activities such as walking, rising from a chair, bathing, and grooming. The limitation of activity and movement leads to deconditioning and increased pain, creating a pain-movement cycle in which arthritis-related pain becomes part of the individual’s everyday life. Treatment goals for such patients focus not on curing the disease but on managing the pain.

Barriers that interfere with pain management must be identified. The authors identified the major internal barriers as: (1) individual beliefs that enduring the pain is preferable to the side effects and costs of treatments, (2) the belief that nurses are too busy to listen or help, and (3) being “stoic” is preferable to worrying others or being labeled a “complainer.” The major external barriers were: (1) lack of a good relationship with healthcare providers or lack of access to care, (2) lack of knowledge about the characteristics of chronic pain in the elderly by the healthcare provider, 3) lack of interest or open-mindedness about approaches to treatment by providers, and (4) lack of understanding of pain as a treatment priority.

A priority for healthcare providers should be a client-provider relationship that promotes open communication free of age-related expectations of pain. During assessments and planning individualized interventions, include patients as active participants in managing pain. Assessment and planning time need to include addressing individual knowledge deficits, the person’s age-related expectations of pain, emotional distress, use of adaptive resources, and ways in which pain affects movement and daily activities. Chronic pain management of the older population may also need to be addressed through educational interventions. Education of both patients and healthcare providers to correct misinformation related to pain and aging and to assist in achieving improved pain management for older adults with arthritis.

Reference

1. Mobily, R. R., Herr, K. A., Clark, M. K., Wallace, R. B. (1994). An epidemiologic analysis of pain in the elderly. The Iowa 65+ Rural Health Study. Journal of Aging and Health, 6, 139–154.
© 2003 National Association of Orthopaedic Nurses