Making gains on chronic pain

A survey reported in the 1 July 2002 issue of the Medical Journal of Australia found there is a high prevalence of pain among nursing home residents in rural NSW and that pain management activities could be substantially improved.

The survey, conducted by Dr William McClean and Associate Professor Nick Higginbotham, involved 917 nursing home residents in 15 nursing homes in northern NSW. At the time of being interviewed, 27.8% of residents said they were experiencing pain. However, for 22% of residents reporting pain there was no record of their receiving analgesic medication, and for 16% of those in pain, no pain treatment of any kind had been ordered.

In an accompanying editorial, Dr Pamela Melding claimed that much of the chronic pain suffered by older people is unnecessary. Their pain could be alleviated by close observation of visual and behavioural indicators of pain and regular treatment with appropriate analgesics.

In this issue of the Journal, two letters again take up the issues raised by McClean, Higginbotham and Melding.

In one letter, Dr C Roger Goucke, President of the Australian Pain Society, says it is not just people in aged care facilities who are living with undiagnosed pain. It is likely that many elderly people living alone in the community are suffering equal, if not worse, pain. This group of people has been identified as a high priority for the development of pain management treatment strategies, which are now well into the development process. The Australian Pain Society will be focusing its strategies on non-drug techniques (eg, exercise, relaxation, lifestyle modification) that can be used by nurses and carers.

Another letter, from a research team including Dr Robert Llewellyn-Jones, of Sydney University's Department of Psychological Medicine, outlines their investigations into chronic pain factors relating to depression in residential care. They found that residents reporting frequent or constant pain were more likely to be depressed than those reporting rare or occasional pain.

After implementing pain management programs at a number of residential care facilities on a trial basis, Llewellyn-Jones and colleagues believe that it is feasible to conduct pain management programs in residential care. This would make it easier for older people in residential care, who may be unable to travel to hospital-based pain management centres, to receive treatment.

The authors conclude that we, as a society, need to change our attitude that pain is an inevitable part of old age.

The Medical Journal of Australia is a publication of the Australian Medical Association.

 CONTACT: Dr C Roger Goucke , Telephone: 08 9346 3263, Fax: 08 9346 3481,

                  Email: roger.goucke@health.wa.gov.au

Dr Robert H Llewellyn-Jones, Telephone: 9477 9151 / 0412 176 527, Fax: 9477 9133, Email: rljones@mail.usyd.edu.au

John Flannery (AMA) 02 6270 5477 / 0419 494 761