Publications
APS Bulletin • Volume 17, Number 1, 2007
Resource Reviews
John D. Loeser, MD, Department Editor
Pain in Older Persons: Progress in Pain Research and Management, Volume 35
Reviewed by Judith A. Turner, PhD
Stephen J. Gibson, Debra K. Weiner (Eds.), Seattle, IASP Press, 2005. Hard cover, 432 pages, ISBN 0-931092-59-0, $81 nonmembers, $66 IASP members.
Persistent pain is prevalent among older adults and can result in difficulty performing daily activities, mood and sleep disturbance, and decreases in social and recreational activities. Because of the growing number of older persons in the U.S., chronic pain could become a major public health problem in the near future. Most clinical research on chronic pain problems, however, has been conducted with younger and middle-aged adults. Relatively little research has focused specifically on pain in older individuals. Similarly, clinicians often have little specialized training in the assessment and treatment of older adults with pain. Pain in Older Persons is a much-needed contribution to the literature in this area.
The volume is well organized, and the chapters, authored by individuals from a variety of professional backgrounds, are uniformly well written and informative. Nineteen chapters are divided into five sections. The first section provides an overview of the epidemiology of pain, including the incidence of pain problems among different age groups, with a focus on musculoskeletal disorders. Part II consists of chapters that cover age-related differences as examined in animal, human experimental, and human acute and chronic clinical pain studies. Part III includes chapters discussing the assessment of pain, function, mood, and psychosocial function in older adults with pain. Part IV covers specific pain treatments as applied to older persons, and Part V contains chapters on specific pain problems commonly experienced by older persons. The chapters are complementary and avoid redundancy (although the epidemiology of specific pain syndromes is covered in several chapters), providing a very comprehensive overview of the current literature (including many studies published as recently as 2005).
The book is valuable for both clinicians and researchers. Keela Herr’s chapter on pain assessment in older adults with verbal communication skills contains a table listing various measures that have been used to assess pain and functioning in older adults. In addition, information concerning constructs assessed by each measure and helpful comments concerning validity and practical considerations are included. The table is supplemented by text with more detailed information and references. The focus on choosing measures appropriate to specific settings (e.g., postoperative care, nursing home) is a useful addition.
Thomas Hadjistavropoulos provides a similarly useful chapter on assessing pain in older persons who have severely limited communication abilities. He provides practical information on the use of Mini Mental State Examination scores to determine whether an older adult can use specific pain measures. The chapter also summarizes research on observational pain assessment measures that are suitable for research and for use in clinical settings. A table with specific recommendations for helping clinicians decide which measure to use is also available.
The chapters in the last two sections of the book provide comprehensive overviews for clinicians. In the section on treatments, Joseph Hanlon, David Guay, and Timothy Ives contribute a chapter on oral analgesics (e.g., nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, tramadol, adjunctive agents). For each medication, the authors provide a brief summary of the mechanism of action, pharmacokinetics, efficacy, adverse effects, drug interactions, precautions, and dosing and administration. Other chapters in this section describe physical, cognitive-behavioral, interventional (e.g., various types of injections, vertebroplasty, kyphoplasty, intrathecal opioid pumps, spinal cord stimulators), complementary and alternative (e.g., glucosamine sulfate, chrondroitin sulfate, acupuncture), and multidisciplinary therapies and summarize evidence for their efficacy. In the section on common painful disorders, chapters focus on the evaluation and treatment of patients with low back, neuropathic, postoperative, or cancer pain.
Pain in Older Persons is one-stop shopping for researchers and clinicians who want a single up-to-date source of information on a wide variety of topics related to pain in older adults. I recommend it for the library (and active use) of all pain researchers and clinicians. Care providers will find many chapters of direct clinical value, and researchers will be guided by the summaries of the literature and needs for future studies.
Dr. Turner is Professor of Psychiatry and Behavioral Sciences and Rehabilitation Medicine at the University of Washington in Seattle.