Pain Management for Older Adults: A Self-Help Guide

Q: Do you see self-help strategies becoming more important as the population ages?
Thomas: With the graying of the baby boom and advances in health care, we are seeing a dramatic increase in the proportion of older adults in society. There are many questions about the extent to which the health care system will be able to meet the needs of the changing demographic. While the effective management of pain will require health care system resources in most cases, effective self-management has the potential of reducing health care visits and the associated costs.

Q: What are some common misconceptions that older persons have about their chronic pain?
Thomas: There are many of these. Sometimes people think of pain in old age as being “natural” and something that needs to be endured. Although pain problems are frequent in old age, they are never “natural.” They are symptoms of disease or underlying pathology and should be treated. Other examples include views that analgesics and pain killers are the only line of defense against chronic pain, whereas we know that a variety of approaches, including psychological pain management strategies, can also play a key role in managing pain.

Q: What is unique about Pain Management for Older Adults: A Self-Help Guide?
Thomas: While there are several self-help books designed to help people manage their pain and cope with associated stress, not much attention has been paid, within the self-help literature, to the management of pain among older adults. Older adults are different in many respects. Age-related changes in our bodies result in the need for different medication dosages. Recommendations for physical activity programs also are different among older adults. Moreover, the types of stressors that older adults face — such as empty nest syndrome and widowhood — tend to be different from those of younger persons. As such, the type of pain management and related stress management information needs to be tailored to the context of the older adult. This is what we hope we have accomplished with our book. The book brings together many clinical experts, representing the disciplines of medicine, clinical psychology, nursing, exercise therapy, kinesiology, dietetics, and pharmacy with vast combined experience in the medical, psychosocial, and physical management of chronic pain.

Q: What kind of clinical experience does each of you have with older patients?
Thomas: My professional training is in clinical psychology. I began clinical work with older adults approximately 18 years ago. After noticing the high frequency of pain problems among older persons, I became very interested in pain assessment and management among seniors. My clinical work with older persons has focused on assessment and psychosocial pain management (e.g., helping people deal with the psychological consequences of chronic pain) in conjunction with regular medical care.

Heather: My clinical practice is quite diverse. Some of my practice is focused on the psychological assessment of people who suffer from chronic pain. I also provide psychological treatment to individuals who have anxiety disorders, mood disorders, or adjustment disorder in response to a medical condition. I use a cognitive-behavioral approach in my work with clients. My work with older adults typically focuses on facilitating adjustment to chronic medical conditions. This work often involves assisting with development of strategies for dealing with pain, depression, or anxiety. The work can also involve helping clients make general changes in their health habits, such as increasing exercise, eating better, or quitting smoking. At the University of Regina, I started a Psychology Training Clinic a number of years ago. At this time, I am exclusively supervising students who are interested in working with older adults who are anxious about their health. This anxiety about health is often triggered by experiences with pain from a variety of medical conditions.

Q: What are some of the ways you keep readers motivated to progress through the book and to start practicing the self-help techniques?
Thomas: We present the information in a language that lay people can relate to and understand. As much as possible, we avoid scientific jargon. Where appropriate, and always using lay language, the book makes reference to scientific evidence that supports the effectiveness of approaches discussed in the book. We include vignettes to illustrate some of the problems and potential solutions that we discuss in the book, and we encourage readers to move slowly as they practice the coping skills discussed in the book. We also provide recording forms to help people monitor their practice, progress, and successes over time.

Q: Do you have a particular story about a patient who used some of the techniques you present in the book to make dramatic improvements in his or her quality of life?
Heather: One client who really stands out for me is an older man who suffered from chronic low back pain resulting from work injuries and surgeries he underwent in his 40s. When I began to work with him, he was extremely angry because he was in pain and he was at a point in his life where he was “supposed to enjoy life.” He was still focused on wanting someone to fix him, and frustrated that no one was willing to operate on him. We used many of the strategies that are discussed in the book. The key to working with him was to ask him to temporarily let go of trying to get someone to operate on him and to start by having him focus on what was in his control and what he could do to improve his pain and life. We worked on changing negative thoughts, incorporating relaxation strategies, scheduling pleasant events, improving his communication with his family, and encouraging a healthy lifestyle. It was the combination of all of the strategies that helped him; no one strategy would have been effective on its own. One thing that was very rewarding about working with this client was that when we started to work together, he was very negative about seeing a psychologist and only came to see me because his wife insisted. As we worked together, however, he really opened up, and now he recommends psychologists to everyone! He no longer even thinks about surgery. He has excellent quality of life, spending time every day exercising, enjoying hobbies, and being with his family.

Q: Why should physicians recommend this book to their older patients?
Thomas: There are very few self-help pain management resources that are specifically tailored for older adults. Most importantly, the book helps foster a sense of control over one’s pain, and we know that people who have an enhanced sense of control over their pain have better outcomes. In addition to describing a variety of self-management coping strategies, the book provides useful educational information about topics such as pain management medication, sleep hygiene, and nutrition. Physicians often provide such information to their patients, but time constraints limit the amount of information they can provide. Having such information available in written form can help patients understand the information, while saving time in the medical office.

Q: What does this book mean to you personally?
Heather: It is very exciting to publish this book with Thomas. It is a great way to mark our 20th wedding anniversary! The strategies that are described in this book have benefited so many clients, and we are pleased that the book will open up these strategies to many older adults who would not normally learn about this approach to pain management.

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Contributing Authors
Introduction
Disclaimer
Acknowledgments

1. Pain among Seniors
   Ronald R. Martin, Thomas Hadjistavropoulos, and Heather D. Hadjistavropoulos
2. Pain and Psychology
   Ronald R. Martin, Thomas Hadjistavropoulos, Jaime Williams, and Heather D. Hadjistavropoulos
3. Taking Control: Effective Pain Management
   Ronald R. Martin, Thomas Hadjistavropoulos, Heather D. Hadjistavropoulos, Sandra M. LeFort, and Shannon Fuchs-Lacelle
4. Pain and Emotion
   Sandra M. LeFort and Ronald R. Martin
5. Social Support, Loneliness, and Pain
   Ronald R. Martin
6. The Role of Exercise in Seniors' Lives
   Nancy K. Turner, Elizabeth L. Harrison, Robert McCulloch, and Ronald R. Martin
7. Living in More Comfort: Maximizing Function and Energy
   Nancy Turner, Elizabeth L. Harrison, Robert McCulloch, and Ronald R. Martin
8. Sleep Hygiene and Nutrition
   Ronald R. Martin, Sandra M. LeFort, Stephanie Cook, and Shannon Fuchs-Lacelle
9. Effective Communication with Your Doctor
   Elan C. Paluck
10. The Role of Medications
    Romayne Gallagher, B. Lynn Beattie, and Ronald R. Martin
11. Information for Caregivers of Older Adults Who Have Dementia
    Thomas Hadjistavropoulos and Ronald R. Martin

Final Thoughts
Pain Management Review
Pain Management Resources from Around the World
Bibliography
Index

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"The self-help program presented in this book was developed by pain researchers and addresses seniors who experience chronic pain. ... The book contains a number of tables, illustrations and, at the end of chapter 1, a 4-page pain checklist which helps to define and circumscribe the pain situation on an individual basis. There is also a list of myths and untruths (such as pain is normal for the elderly, etc.) which have to be dispelled to convince seniors to seek help and efficiently take care of their pain. In the same way, chapter 2, ‘Pain and Psychology’ proposes a pain diary which helps to define as precisely as possible the type, nature and intensity of pain. Chapter 6 on exercise gives details with rich illustrations on movements to be performed. The importance of natural posture is illustrated in chapter 7, as well as the right way to set up the work place, as postural problems play an important role in osteoarticular pain. The book is very user-friendly. It deserves to be translated into other European languages and distributed to organizations caring for elderly people."
Gerontology; May 26, 2009, reviewed by Dr. L. Robert (read full review)

"This manual fills a niche with its specific focus on orientating the information provided to the unique life circumstances of older adults. ... Health care professionals will find the guide very useful as a support for treatment of older patients with persistent pain problems, especially if they familiarize themselves with the checklists and other tools, and make use of these resources to assist their patients in building self-help capacity for pain management. Older adults who heed the advice to use the manual in consultation with appropriate health professionals will obtain the maximum value, but even those who elect to use the manual independently will enhance their knowledge about important lifestyle, behavioural and interventional-related issues that influence the course and intensity of their persistent pain problems."
Pain Research and Management (Volume 13, Number 5, September/October 2008), reviewed by Maggie Gibson (read full review)

"I found this book to be very helpful. It offers self-assessment checklists, progress charts, photos and illustrations, and simple instructions for managing persistent pain."
The Pain Community News, newsletter of the American Pain Foundation (Fall 2008,Volume 8, Issue 3), reviewed by Mary McHughes

"It is a pleasure to see a book aimed at those who suffer from chronic pain that does not resort to alternative medical strategies of little proven benefit. Furthermore, the book carries the strong message that reducing one's pain is a function of the physical and psychological work that the sufferer undertakes. ... I think that this book could be an important accessory for those who provide care to the geriatric population."
APS Bulletin (Volume 18, Number 2, 2008), reviewed by Dr. John D. Loeser (read full review)

"The authors are experts in their fields and the comprehensive information [is] set out in a clear and usable manner. Professionals might want to have this guide available and copy pages for their patients. It would be a useful resource in residential care, as well as being a 'bible' to any older adult with pain or caring for someone in pain."
Alzheimers News, The National Newsletter of the Alzheimers New Zealand Inc. (Issue 75, September 2008), reviewed by Dr. Chris Perkins

"The text is carefully and clearly written with chapter-long discussions of topics which often include useful charts and diagrams. This reader-friendly book, which is published in ample-sized print, has several strengths beginning with its sensitivity to older adults (not simple referring to them in the title as 'seniors' as in other guides). ... Emphasis is given to realistic goals and resisting thoughts that bring on depression and despondency."
Fibromyalgia Frontiers, The Quarterly Journals of the National Fibromyalgia Partnership, Inc. (2008, Volume 16, Number 2)

"I was impressed by this book. In clear language it describes what pain is, how it should be assessed (questionnaires, scales, etc), and how it can be effectively managed. There are chapters on the psychosocial aspects of pain as well as the role of exercise and nutrition. The sections on physical care and exercise are well illustrated with photographs. In general, chronic pain is often not well treated or fully appreciated, and I think this book would be a useful resource for an older adult seeking practical solutions for managing their chronic pain."
e-Newsletter from the International Association for Hospice and Palliative Care, reviewed by Roger Woodruff, May 2008

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