Pain Relief for Older Adults

In A Sceptic’s Medical Dictionary (London:BMJ Books, 1997), Michael O’Donnell describes clinical experience as, “Making the same mistakes with increasing confidence over an impressive number of years” and evidence-based medicine as, “Perpetuating other people’s mistakes instead of your own.” Like most good humour, there is a large amount of truth in these definitions. Our theme in this issue is pain relief in older adults. Among the articles, we look at traditional methods of pain relief. It is good to remind ourselves that long experience with these modalities is not a guarantee that they are more effective than placebo. On the other hand, absence of proof of effectiveness does not mean the same as proof of absence. Many traditional remedies are clearly worthy of proper study. However, when patients tell me that natural products by definition must be safe, I feel compelled to remind them that arsenic, strychnine, digoxin, and many others, are very dangerous natural products.

Our theme this month, as I mentioned, is on pain relief. Probably the two commonest sources of pain that patients complain of to their family doctor are joint pain and abdominal pain. One of these is covered in our CME article for this edition, namely “Chronic Abdominal Pain: A Real Pain in the Gut” by Dr. Grant Chen. We have an article on “Traditional Chinese Medicine for Chronic Pain: The Oldest Medicine for Older Adults” by Mary Wu as well as a more specific article on “Acupuncture for Pain Management’ by Dr. Linda Rapson and Dr. Robert Banner. Our Musculoskeletal column for this month is also related to our focus: “Managing Rotator Cuff Injury: Can Acupuncture Add Increments to the Current Protocol? Inference from a Case Study” by Dr. Sanjeev Rastogi, Dr. Rajeev Rastogi and Dr. Ranjana Rastogi.

As usual we also have a variety of articles on other topics. Our Men’s Health article is “Bone Densitometry among Older Men: Indications and Interpretation” by Dr. John Schousboe. Our CVD column is on “Revascularization for Peripheral Arterial Disease among Older Adults: Referral, Management, and Prognosis” by Dr. Marc Schermerhorn and Dr. Kristina Giles. The article on Drug Safety, “Benzodiazepine Use among Older Adults: A Problem for Family Medicine?” is by Dr. Steve Illiffe, and we also have an article on a very common medical problem, “Aspiration Pneumonia among Older Adults” by Dr. R.A. Harrison and Dr. T.J. Marrie. Finally, our Dementia column is written by two well known clinical experts (and colleagues of mine) Dr. David Tang-Wai and Dr. Naida L. Graham. Their article is entitled “Assessment of Language Function in Dementia.”

Enjoy this issue.
Barry Goldlist