Tips for Interdisciplinary Pain Management in Older Patients

courtesy ACR Daily News

CHICAGO—Rheumatology healthcare providers should embrace collaborative approaches to manage chronic musculoskeletal pain in older adult patients, including models of care that involve multiple providers, patients and their caregivers. That was the message delivered by two speakers in the Interdisciplinary Management of Chronic Musculo­skeletal Pain in Older Adults session at the 2018 ACR/ARHP Annual Meeting.

“As musculoskeletal specialists, it is particularly appropriate [we] focus on the aging population. The National Institute on Aging predicts a very large increase in disability will be caused by increases in age-related disease, and arthritis and back pain are at the top of that list.¹ This has enormous implications for social support systems, resources and our economy,” said Una E. Makris, MD, MSc, associate professor of medicine at UT Southwestern Medical Center, Dallas.

Although chronic pain prevalence statistics vary, as many as 80% of people in nursing homes will experience chronic pain.² “We know that aging is a risk factor for chronic musculoskeletal pain. We also know that pain in later life increases the risk for multiple adverse effects,” including falls and fracture, depression and/or anxiety, and frailty and mobility problems, she said.^3-5

Chronic Pain: Disabling & Costly

Chronic back pain in older adults is a particular concern: It is the most common chronic pain condition reported by adults and the second most common reason for a medical office visit, and for disability.^6,7 Its management and impact are costly: Direct and indirect costs related to low back pain exceeded $100 billion in 2005 dollars.⁸ Although the number of diagnostic tests and therapies has increased, patient-reported—and general—outcomes have not improved, she said.

Based on focus group research among older adults with chronic back pain living in New York, Dr. Makris and her colleagues identified important domains related to patients’ experience, including sleep, fatigue, social isolation, physical activity, emotional health and relationships with family and friends, that are potential targets for treatment intervention.⁹

“Chronic back pain is complex and multi­factorial. The majority of older adults will have degenerative changes of lumbar spine imaging, but not everyone has chronic back pain. Of those individuals who do, not everyone experiences disability. We know that some of the discrepancies that may account for differences between imaging, clinical presentations and response to therapy are indeed these psychosocial factors which are known to influence the course of disease,” and contribute to the phenotype and multiple clinical presentations of back pain that rheumatologists see in their older patients, she said.¹⁰