I have served on the Chief Coroner of Ontarios Geriatric and Long Term Care Review Committee (GLTCRC) ever since its inception almost 15 years ago. We have reviewed hundreds of problematic cases, and many that provide excellent learning opportunities for those who read the reports (a report from the committee is published annually). One of my colleagues on that committee, Barry Wilson (who tragically died young), early on noted the lack of attention to palliative care and pain management among older patients who did not have a malignancy. We were in the process of writing a paper on the topic when Dr. Wilson suddenly died, and we did not continue on that project.
Since that time, however, there has been an explosion of interest in the topic of pain in older adults. Virtually every article arrives at the same conclusion: not enough care or attention is spent on ensuring pain relief in older patients, particularly in those who are demented or delirious and cannot request pain relief. I do numerous in-hospital consults to patients with severe pain who are also delirious, and I am amazed that so many of these patients are prescribed analgesics PRN. How likely is it that a patient with a major incision will not be in pain postoperatively? Some of my most gratifying interventions are simply recommending that pain medication be given on a regular basis. Recent articles have suggested that inadequately treated peri-operative pain is a more potent cause of delirium than is adequate analgesia.
Providing effective, non-toxic pain relief in older adults is not always an easy task. However, it is an impossible task if the presence and importance of the pain is not appreciated by health care providers. This months issue is as valuable for the emphasis on how important it is to treat pain as it is for the actual clinical pearls we gain about treating specific pain problems.
Drs. Sharon Watanabe and Yoko Tarumi tackle the issue of managing cancer pain in older adults, while Dr. Jacqueline Gardner-Nix discusses chronic noncancer pain management, material from which thismonths online CME program has been based. Our Associate Editor, Dr. Madhuri Reddy, discusses the issue of chronic wound pain in older adults, her area of special interest, while Dr. Arthur Bookman stresses both diagnostic acumen and pain relief in his article on musculoskeletal pain.
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