Pain in the elderly. Rating scales, prevalence and verbal expression of pain and pain relief

Abstract: Aims: The overall purpose of the studies was to examine the prevalence of pain in elderly people and to evaluate the applicability of pain scales in assessing pain and pain relief in elderly patients.Methods: In Paper I, 167 geriatric patients (M=81 years) rated their current experience of pain twice with a 5-minute interval in between on the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numerical Rating Scale (NRS), and were then asked if they experienced pain, ache or hurt or other symptoms. In Paper II, 53 geriatric patients (M=82 years) rated their pain on the VAS, GRS and NRS in connection with the administration of analgesics. This was repeated after 1.5-2 hours and a direct question was asked about whether the analgesic medication given in connection with the initial assessment had had any pain-alleviation effect. The patients also rated pain relief on the Pain Relief Scale (PRS). The study in paper III, was conducted within the framework of the Gerontological and Geriatric Population Studies in Göteborg, Sweden (H70), 241 70-year-old men and women were assessed regarding pain experience, cognitive function and depressive symptoms. In Paper IV, 38 patients who have undergone hip replacement surgery due to Cox arthritis (M=75 years) and 22 patients with a surgically repaired hip fracture (M=81 years) were interviewed on the second day after the operation. This was divided into two parts, one tape-recorded and semi-structured in character and a structured interview.Results: In Paper I, 71% of the patients verbally reported pain when at rest and/or when moving. High and significant correlations were obtained both between the ratings on the VAS, GRS and NRS (p<0.001) and between the test and retesting (p<0.001). The probability of accomplishing a rating on the pain scales decreased with advancing age of the patient. The probability of agreement between the patients ratings of pain and the verbal report of pain tended to decrease with advancing age. Those patients who verbally denied having pain but reported pain on the scales, rated it significantly lower (p<0.001) than those who verbally reported pain and rated the pain as well. The results in Paper II show that the probability of accomplishing a rating on the VAS, GRS, NRS and PRS decreased with advancing age of the patient. The correlations between the ratings on the VAS, GRS and NRS were strong and significant (p<0.001) both at the initial assessments and at the re-assessments. The verbally reported effects of the analgesics were often directly contrary to the changes in rated pain. The results in Paper III show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and pain experience were more evident in men. In Paper IV, the majority of the elderly patients who participated in this study verbally reported pain and spontaneously used a large number of the words listed in the Short Form McGill Pain Questionnaire (SF-MPQ) and Pain-O-Meter (POM). The patients also used a number of additional words that are not found in the SF-MPQ or the POM. Conclusions: The results suggest pain is common in 70-year-old people and in elderly patients as well. Pain scales such as the VAS, GRS, NRS and PRS can be used to assess elderly patients' experience of pain and pain relief in combination with alternative expressions of pain, pain relief, discomfort and distress. The words of the SF-MPQ and POM are to be found in elderly patients descriptions of pain in everyday language.