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Pain Report #11- Pain Management for the Elderly

How Aging Affects Perception

The effect of aging on pain perception has been a topic of interest for many years. Elderly persons often present with altered presentation of common diseases. For example, older people have been observed to present with apparently painless myocardial infarction and painless intra-abdominal catastrophes. The extent to which these observations are attributable to age-related changes in pain perception remains uncertain. Anatomical studies, as summarized in Table 1, have observed some age-related changes in the nervous system that might alter pain perception. Some of these findings include decreased numbers of various pain receptors in the skin and other organs, altered nerve conduction, and some central nervous system changes that may affect sensory processing. Unfortunately, most of these studies were based on cross-sectional studies of animal and postmortem specimens for which little or no data was actually available or correlated with the pre-mortem pain experiences.

(Figure 1)

Likewise, a large number of physiologic studies of pain perception also exist. These studies typically use a heat probe, electrical stimulation, or other method to induce pain in volunteers in an effort to identify a pain threshold or pain tolerance level. These studies have shown mixed results; some showed increase, some showed decrease, and some showed no change in pain perception with aging in normal volunteers. Moreover, it has been difficult to conduct a formal meta-analysis using all of these studies because of flaws concerning sampling errors and methodological differences. In the final analysis, most investigators have concluded that actual age-associated changes in pain perception are subtle and probably not clinically significant.

On the other hand, elderly people often present with concurrent illness and sensory impairments that may mask pain complaints. Cognitive impairment, sensory neuropathies, visual and hearing impairments all may make communication of pain complaints more difficult and thus appear to be a perceptual problem. Elderly patients may be more stoic, expect pain with aging, fear diagnostic tests or other interventions, and may fear the meaning of pain. These issues make pain assessment and measurement much more difficult.

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