Originally created 05/11/02

Dealing effectively with persistent pain

WASHINGTON - Doctors and their older patients alike tend to pass off persistent pain as just one of the changes that goes along with aging.

But it's not, and people shouldn't think that way, according to a new set of guidelines released Thursday by the American Geriatrics Society.

"A common response that I hear is, 'We're just getting old.' But this is not a normal part of aging," said Dr. Michael Gloth, chief of geriatrics at Union Memorial Hospital in Baltimore and an expert on persistent pain.

That attitude is one of the biggest obstacles for people seeking pain relief, according to the panel of experts who described the guidelines. Persistent pain is often known as chronic pain, a negative label.

When Elizabeth Winchester, 76, was released from the hospital after surgery to remove a cancerous lung tumor, she said she wasn't given adequate pain medication.

"I was so much in pain," said Winchester, of Timonium, Md. "When I said that to the surgeon, he said, 'If I told you how much pain you'd be in, you never would have had the operation.' "

When asked why she wasn't given the proper drugs to treat her pain, she said, "Because he's never had the operation."

Enter Gloth, who quickly prescribed the powerful OxyContin narcotic and Vioxx, an anti-inflammatory pain reliever.

"He has been my lifesaver," Winchester said, describing him as one of the few doctors "who will listen to what you say."

The first step in changing people's attitudes is to change the description of pain from chronic to persistent, said Dr. Bruce Ferrell, an associate professor in geriatrics at the UCLA School of Medicine. He is also president of the American Geriatrics Society.

"Persistent pain has a more positive spin," he said. "It's not a negative or bad thing to have persistent pain, because it can be treated and it can be made better."

The guidelines also recommend that doctors first try over-the-counter drugs such as Tylenol to treat pain, but to avoid drugs such as Aleve for long-term therapy because they tend to cause gastro-intestinal bleeding in older people.

For long-term therapy, the guidelines recommend prescribing "COX-2 inhibitor" drugs such as Celebrex and Vioxx, because they don't cause bleeding.

The publication admonishes doctors who give patients placebos, or sugar pills, and tell them the pills will make the pain go away. They call the use of placebos unethical "and there is no place for their use in the management of persistent pain."

In a note to doctors and patients, the guidelines tell doctors to learn better how to assess pain, especially in older people who cannot communicate clearly, and they encourage patients to be "their own best advocate" in seeking the proper pain relief.

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