Applied Evidence

AGING: Are these 4 pain myths complicating care?

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Is pain a natural part of aging? Does “toughing it out” make pain more tolerable? Read on to see what the evidence really says regarding 4 common misconceptions about pain and aging.


 

References

Beliefs about aging itself can also have dramatic consequences, both positive and negative. In one longitudinal study, those who had positive self-perceptions of aging when they were 50 had better health during 2 decades of follow-up and lived, on average, 7½ years longer than those who had negative self-perceptions at the age of 50.4

Although little research has focused specifically on pain-related stereotypes held by older adults, their importance has long been recognized.

Twenty years ago, a review found that the failure to incorporate older patients’ beliefs about pain could have a negative effect on pain management.5 And in 2011, an Institute of Medicine report found a critical need for public education to counter the myths, misunderstandings, stereotypes, and stigma that hinder pain management in patients across the lifespan.6

We set out to identify widely held stereotypes that older adults and physicians have about pain—and to report on primary studies that support or refute them. We focused on noncancer pain. In the pages that follow, we identify 4 key stereotypes that misrepresent the experience of older adults with regard to pain, and present evidence to debunk them.

Stereotype #1: Pain is a natural part of getting older

Chronic pain is often perceived as an age-related condition. In in-depth interviews, older adults with osteoarthritis reported pain as a normal, even essential, part of life. As one patient put it, “That’s how you know you’re alive … you ache.”7

Among primary care patients with osteoarthritis, those older than 70 years were more likely than younger patients to believe that people should expect to live with pain as they get older.8 And more than half of older adults who responded to a community-based survey considered arthritis to be a natural part of getting old.9

Physicians, too, often view pain as an inevitable part of the aging process, giving patients feedback such as “What do you expect? You’re just getting older.”10

Are they right?

Is pain inevitable? No
In fact, chronic pain is common in older adults, occurring in more than half of those assessed, according to some studies.11 In addition, some epidemiological studies have found an age-related increase in the prevalence of pain,12-14 with older age predicting a more likely onset of, and failure to recover from, persistent pain.15 But numerous studies have failed to find a direct relationship between pain and age.

A National Center for Health Statistics report found that 29% of adults between the ages of 45 and 64 years vs 21% of those 65 or older reported pain lasting >24 hours in the month before the survey.16 And a meta-analysis comparing age-related differences in pain perception found that the highest prevalence of chronic pain occurred at about age 65; a slight decline with advancing age followed, even beyond the age of 85.17

Chronic pain disorders are less frequent. In fact, many chronic pain disorders occur less frequently with advancing age. Population-based studies have found a lower prevalence of low back, neck, and face pain among older adults compared with their younger counterparts;16 evidence has also found lower rates of headache and abdominal pain.18 Other epidemiological studies suggest that the prevalence of musculoskeletal pain generally declines with advancing age,19 and a study of patients in their last 2 years of life found pain to be inversely correlated with age.20 These findings refute the stereotype that advancing age inexorably involves pain, and challenge the notion that pain in later life is normal and expected, and unworthy of treatment.

Stereotype #2: Pain worsens
over time

Some patients and physicians expect that as people age, their pain will increase in intensity. In one study of community-dwelling older adults, 87% of those surveyed rated the belief that more aches and pains are an accepted part of aging as definitely or somewhat true.21 Indeed, patients of all ages have expressed the belief that older age confers greater susceptibility to, and suffering from, painful conditions like arthritis.22 Many common causes of pain in older adults, especially osteoarthritis, are seen as resulting from degenerative changes, which worsen over time.23

Does pain intensify? Not necessarily
Some studies have linked older age to a worse prognosis for patients with musculoskeletal pain, but a greater number have found that aging has no effect on it.24

Pain does not always progress. In a large cohort of patients with peripheral joint osteoarthritis, radiographic joint space narrowing worsened over 3 years, but this did not correlate consistently with worsening pain.25 When the same cohort was assessed after 8 years, there was significant variability in pain, with no clear progression.26

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