Introduction

The International Association for the Study of Pain (IASP) defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Chronic pain has several different meanings in medicine. Distinction between acute and chronic pain has relied upon an arbitrary duration of the pain. The distinction varies from 6 months to 1 year.  Chronic pain is simply defined as “as a disease state, with pain persisting beyond a reasonable period of time required for healing”. It is a pathological process that causes continuous or recurring pain lasting for months or years.

Chronic pain may be divided into

• “nociceptive” (caused by activation of nociceptors or pain receptors), and
• “neuropathic” (caused by damage to or malfunction of the nervous system).
• Mixed, a mixture of the above 2 main types

Common condition in elderly with chronic pain is as below:

A. Some common Nociceptive Pain is as follows:

1. Postoperative, post-trauma
2. Rheumatoid or osteoarthritis
3. Myofacial pain syndromes
4. Ischemic disorders (where there is decreased blood supply)
5. Cancer
6. Chronic back pain
7. Ulcers, diseases of the viscera (internal organs of the body)

B. Some common Neuropathic Pain in elderly are as follows:

1. Trigeminal neuralgia
2. Post-herpetic neuralgia (after shingles)
3. Post-stroke pain
4. Phantom pain (occurs in amputated limbs)
5. Diabetic neuropathies

Symptoms / Signs

Nociceptive pain may be divided into

• “superficial somatic” and
• “deep” pain which can be “deep somatic” or “visceral pain”

Superficial somatic pain is causes by activation of nociceptors in the skin or superficial tissues.

Deep somatic pain is causes by stimulation of pain receptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain.

Visceral pain originates in the viscera organ which is often very difficult to locate. Also several visceral regions produce “referred” pain when injured, where the sensation is located in an area distant from the original site of pathology or injury. Anginal chest pain referring to neck is an example.

Neuropathic pain is divided into “peripheral” (originating in the peripheral nervous system), “central” (originating in the brain or spinal cord) and “sympathetic”.

Peripheral neuropathic pain is often described as “burning,” “tingling,” “electric current,” “stabbing,” “numbness” or “pins and needles.”

Complications

Delay of appropriate treatment in chronic pain prolongs misery and leads to irreversible pathologies. Chronic pain has many psycho-social components that must be dealt with quickly before depression becomes a part of the clinical picture.Chronic Pain should be recognized as a multi-factorial disease state requiring intervention at many levels. The complicating problems are as follows:

1. Psychologically pain causes suffering and undue misery! Mood get changed and person with pain gets irritable. Sleep disturbance is a real issue. Some patients get isolated with decreased socialization and eventually depressed.
2. Functionally many elderly need help for their daily activities as a lot of them have impaired ambulation as a result of pain.
3. There are instances of older patients becoming delirious and restless when they are in pain and this is especially so in those who are cognitively impaired.

There will be increased healthcare utilization and costs too.

Treatment

• Successful pain treatment is highly dependent on successful resolution of the cause of the pain.
• Acute pain will stop when an injury heals or when an underlying problem is treated successfully.
• Chronic pain and abnormal pain has a psycho-social component that must be dealt with before depression becomes a part of the clinical picture. They are more difficult to treat as the original reason for the pain in now altered by other reasons e.g. psychosocial influences, spirituality, financial issues etc.
• Seek further medical help/advice if your pain symptoms persist.