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Pain in older people with frailty

Published online by Cambridge University Press:  03 November 2015

Lesley Brown ,
John Young ,
Andrew Clegg  and
Anne Heaven
Lesley Brown*
Affiliation:
Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
John Young
Affiliation:
Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
Andrew Clegg
Affiliation:
Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
Anne Heaven
Affiliation:
Academic Unit of Elderly Care and Rehabilitation, University of Leeds and Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
*
Address for correspondence: Dr Lesley Brown, Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, West Yorkshire, UK. Email: Lesley.Brown@bthft.nhs.uk
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Summary

In this review we identified cohort and cross-sectional studies that assessed pain in community-dwelling older people (>65 years) reliably characterized as frail. Secondly, we considered biologically plausible mechanisms that may alter pain perception, or contribute to, or exacerbate pain in an older person with frailty. Thirdly, we considered specific implications of pain management for this group of people. From the limited data from the seven included studies, it would appear that the presence of pain is higher in older people with frailty compared with people characterized as pre-frail or not frail. Thus older people reporting pain are more likely to be frail. However, a lack of prospective data precludes inferences about the direction of the relationship: that is whether pain or frailty is the antecedent. Further research is needed to understand the direction of the relationship, and to identify appropriate pain management strategies for older people with frailty.

Keywords

older peoplefrailtypainanalgesia
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 25 , Issue 3 , August 2015 , pp. 159 - 171
Copyright
Copyright © Cambridge University Press 2015 

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References

1Laiho, K, Tuomilehto, J, Tilvis, R. Prevalence of rheumatoid arthritis and musculoskeletal diseases in the elderly population. Rheumatol Int 2001; 20: 85–87.CrossRefGoogle ScholarPubMed
2Davis, MP, Srivastava, M. Demographics, assessment and management of pain in the elderly. Drugs Aging 2003; 20: 23–57.CrossRefGoogle ScholarPubMed
3Maxwell, CJ, Dalby, DM, Slater, Met al.The prevalence and management of current daily pain among older home care clients. Pain 2008; 138: 208–16.CrossRefGoogle ScholarPubMed
4Clegg, A, Young, J, Iliffe, S, Rikkert, MO, Rockwood, K. Frailty in elderly people. Lancet 2013; 381: 752–62.CrossRefGoogle ScholarPubMed
5Fried, LP, Tangen, CM, Walston, Jet al.Frailty in older adults evidence for a phenotype. J Gerontol Series A: Biol Sci Med Sci 2001; 56: M146–57.CrossRefGoogle ScholarPubMed
6Rockwood, K, Song, X, MacKnight, Cet al.A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 2005; 173: 489–95.CrossRefGoogle ScholarPubMed
7Harrison, JK, Clegg, A, Conroy, SP, Young, J. Managing frailty as a long-term condition. Age Ageing 2015; 44: 732–35.CrossRefGoogle ScholarPubMed
8Weaver, GD, Kuo, YF, Raji, MAet al.Pain and disability in older Mexican-American adults. J Am Geriatr Soc 2009; 57: 992–99.CrossRefGoogle ScholarPubMed
9Rudy, TE, Weiner, DK, Lieber, SJ, Slaboda, J, Boston, JR. The impact of chronic low back pain on older adults: a comparative study of patients and controls. Pain 2007; 131: 293–301.CrossRefGoogle ScholarPubMed
10AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatrics Soc 2002; 50 (suppl): S205.CrossRefGoogle Scholar
11Shega, JW, Dale, W, Andrew, M, Paice, J, Rockwood, K, Weiner, DK. Persistent pain and frailty: a case for homeostenosis. J Am Geriatrics Soc 2012; 60: 113–17.CrossRefGoogle ScholarPubMed
12Wiech, K, Ploner, M, Tracey, I. Neurocognitive aspects of pain perception. Trends Cog Sci 2008; 12: 306–13.CrossRefGoogle ScholarPubMed
13Lin, C-C, Li, C-I, Chang, C-Ket al.Reduced health-related quality of life in elders with frailty: a cross-sectional study of community-dwelling elders in Taiwan. PLoS One 2011; 6: e21841.CrossRefGoogle ScholarPubMed
14Chen, Q, Hayman, LL, Shmerling, RH, Bean, JF, Leveille, SG. Characteristics of chronic pain associated with sleep difficulty in older adults: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study. J Am Geriatr Soc 2011; 59: 1385–92.CrossRefGoogle ScholarPubMed
15Clegg, A, Rogers, L, Young, J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing 2014; 44: 148–52.CrossRefGoogle ScholarPubMed
16Mezuk, B, Edwards, L, Lohman, M, Choi, M, Lapane, K. Depression and frailty in later life: a synthetic review. Int J Geriatric Psychiatry 2012; 27: 879–92.CrossRefGoogle ScholarPubMed
17Shega, JW, Andrew, M, Kotwal, Aet al.Relationship between persistent pain and 5-year mortality: a population-based prospective cohort study. J Am Geriatr Soc 2013; 61: 2135–41.CrossRefGoogle ScholarPubMed
18Blyth, FM, Cumming, RG, Nicholas, MKet al.Intrusive pain and worry about health in older men: the CHAMP study. Pain 2011; 152: 447–52.CrossRefGoogle ScholarPubMed
19Blyth, FM, Rochat, S, Cumming, RGet al.Pain, frailty and comorbidity on older men: The CHAMP study. Pain 2008; 140: 224–30.CrossRefGoogle ScholarPubMed
20Koponen, MP, Bell, JS, Karttunen, NM, Nykanen, IA, Desplenter, FA, Hartikainen, SA. Analgesic use and frailty among community-dwelling older people: a population-based study. Drugs Aging 2013; 30: 129–36.CrossRefGoogle ScholarPubMed
21Chang, C-I, Chan, D-C, Kuo, K-N, Hsiung, CA, Chen, C-Y. Prevalence and correlates of geriatric frailty in a northern Taiwan community. J Formosan Med Assoc 2011; 110: 247–57.CrossRefGoogle Scholar
22Miguel Rde, C, Dias, RC, Dias, JM, da Silva, SL, Menicucci Filho, PR, Ribeiro, TM. Frailty syndrome in the community-dwelling elderly with osteoarthritis. Revista brasileira de reumatologia 2012; 52: 339–47.Google ScholarPubMed
23Lenardt, MH, Carneiro, NHK, Albino, JS, Willig, MH. Quality of life of frail elderly users of the primary care. Acta Paulista de Enfermagem 2014; 27: 399–404.CrossRefGoogle Scholar
24Gibson, SJ, Farrell, M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clinical J Pain 2004; 20: 227–39.CrossRefGoogle ScholarPubMed
25Le Bars, D, Dickenson, AH, Besson, JM. Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain 1979; 6: 283–304.CrossRefGoogle ScholarPubMed
26Roby-Brami, A, Bussel, B, Willer, JC, Le Bars, D. An electrophysiological investigation into the pain-relieving effects of heterotopic nociceptive stimuli. Probable involvement of a supraspinal loop. Brain 1987; 110:1497–508.CrossRefGoogle ScholarPubMed
27Price, DD, McHaffie, JG. Effects of heterotopic conditioning stimuli on first and second pain: a psychophysical evaluation in humans. Pain 1988; 34: 245–52.CrossRefGoogle Scholar
28Le Bars, D, Chitour, D, Kraus, E, Dickenson, AH, Besson, JM. Effect of naloxone upon diffuse noxious inhibitory controls (DNIC) in the rat. Brain Res 1981; 204: 387–402.CrossRefGoogle ScholarPubMed
29Lariviere, M, Goffaux, P, Marchand, S, Julien, N. Changes in pain perception and descending inhibitory controls start at middle age in healthy adults. Clin J Pain 2007; 23: 506–10.CrossRefGoogle ScholarPubMed
30Riley, JL 3rd, King, CD, Wong, F, Fillingim, RB, Mauderli, AP. Lack of endogenous modulation and reduced decay of prolonged heat pain in older adults. Pain 2010; 150: 153–60.CrossRefGoogle ScholarPubMed
31Washington, LL, Gibson, SJ, Helme, RD. Age-related differences in the endogenous analgesic response to repeated cold water immersion in human volunteers. Pain 2000; 89: 89–96.CrossRefGoogle ScholarPubMed
32Lautenbacher, S. Experimental approaches in the study of pain in the elderly. Pain Medicine 2012; 13 (suppl): S44–50.CrossRefGoogle Scholar
33NÃ-Mhaoláin, AM, Fan, CW, Romero-Ortuno, Ret al.Frailty, depression, and anxiety in later life. Int Psychogeriatrics; 24 (special issue 08): 1265–74.CrossRefGoogle Scholar
34Tang, J, Gibson, SJ. A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain 2005; 6: 612–19.CrossRefGoogle ScholarPubMed
35Rhudy, JL, Meagher, MW. Fear and anxiety: divergent effects on human pain thresholds. Pain 2000; 84: 65–75.CrossRefGoogle ScholarPubMed
36James, JE, Hardardottir, D. Influence of attention focus and trait anxiety on tolerance of acute pain. Br J Health Psychol 2002; 7: 149–62.CrossRefGoogle ScholarPubMed
37Jones, A, Spindler, H, Jørgensen, MM, Zachariae, R. The effect of situation-evoked anxiety and gender on pain report using the cold pressor test. Scand J Psychol 2002; 43: 307–13.CrossRefGoogle ScholarPubMed
38Thompson, T, Keogh, E, French, CC, Davis, R. Anxiety sensitivity and pain: generalisability across noxious stimuli. Pain 2008; 134: 187–96.CrossRefGoogle ScholarPubMed
39Carter, LE, McNeil, DW, Vowles, KEet al.Effects of emotion on pain reports, tolerance and physiology. Pain Res Management 2002; 7: 21–30.CrossRefGoogle ScholarPubMed
40Colloca, L, Benedetti, F. Nocebo hyperalgesia: how anxiety is turned into pain. Curr Opin Anesthesiol 2007; 20: 435–39.CrossRefGoogle ScholarPubMed
41Goesling, J, Clauw, DJ, Hassett, AL. Pain and depression: an integrative review of neurobiological and psychological factors. Curr Psychiatry Reports 2013; 15: 1–8.CrossRefGoogle ScholarPubMed
42Zale, EL, Lange, KL, Fields, SA, Ditre, JW. The relation between pain-related fear and disability: a meta-analysis. J Pain 2013; 14: 1019–30.CrossRefGoogle ScholarPubMed
43Vlaeyen, JW, Linton, SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85: 317–32.CrossRefGoogle ScholarPubMed
44Theou, O, Rockwood, MR, Mitnitski, A, Rockwood, K. Disability and co-morbidity in relation to frailty: how much do they overlap? Archives Gerontol Geriatrics 2012; 55: e1–8.CrossRefGoogle ScholarPubMed
45Eeles, EM, White, SV, O'Mahony, SM, Bayer, AJ, Hubbard, RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing 2012; 41: 412–16.CrossRefGoogle ScholarPubMed
46Boyle, PA, Buchman, AS, Wilson, RS, Leurgans, SE, Bennett, DA. Physical frailty is associated with incident mild cognitive impairment in community-based older persons. J Am Geriatr Soc 2010; 58: 248–55.CrossRefGoogle ScholarPubMed
47Buchman, AS, Boyle, PA, Wilson, RS, Tang, Y, Bennett, DA. Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderly. Psychosom Med 2007; 69: 483–89.CrossRefGoogle ScholarPubMed
48Herr, KA, Garand, L. Assessment and measurement of pain in older adults. Clin Geriatric Med 2001; 17: 457.CrossRefGoogle ScholarPubMed
49Parmelee, PA. Pain in cognitively impaired older persons. Clin Geriatric Med 1996; 12: 473–87.CrossRefGoogle ScholarPubMed
50Bernabei, R, Gambassi, G, Lapane, Ket al.Management of pain in elderly patients with cancer. JAMA 1998; 279: 1877–82.CrossRefGoogle ScholarPubMed
51van Ojik, AL, Jansen, PA, Brouwers, JR, van Roon, EN. Treatment of chronic pain in older people: evidence-based choice of strong-acting opioids. Drugs Aging 2012; 29: 615–25.CrossRefGoogle ScholarPubMed
52Davis, GC, Hiemenz, ML, White, TL. Barriers to managing chronic pain of older adults with arthritis. J Nurs Scholarsh 2002; 34: 121–26.CrossRefGoogle ScholarPubMed
53Smith, H, Bruckenthal, P. Implications of opioid analgesia for medically complicated patients. Drugs Aging 2010; 27: 417–33.CrossRefGoogle ScholarPubMed
54McLachlan, AJ, Bath, S, Naganathan, Vet al.Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment. Br J Clin Pharmacol 2011; 71: 351–64.CrossRefGoogle ScholarPubMed
55Clegg, A, Relton, C, Young, J, Witham, M. Improving recruitment of older people to clinical trials: use of the cohort multiple randomised controlled trial design. Age Ageing 2015; 44: 547–50.CrossRefGoogle ScholarPubMed
56Lautenbacher, S. Experimental approaches in the study of pain in the elderly. Pain Med 2012;13 (suppl 2): S44–50.CrossRefGoogle Scholar
57Collard, RM, Boter, H, Schoevers, RA, Oude Voshaar, RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60: 1487–92.CrossRefGoogle ScholarPubMed