Alexander K. Smith, MD, MS, MPH
November 1, 2010
In the first study to look at the prevalence of pain experienced among older people during the last two years of life, researchers at the San Francisco VA Medical Center found that 46 percent of study participants suffered moderate to severe pain during their final four months of life.
The researchers also found that more than one quarter of the participants had moderate to severe pain during the last two years of life, and that arthritis was the biggest single predictor of pain, outweighing all eventual causes of death, including cancer.
“The impact of arthritis on the experience of pain among older adults has not been recognized to the extent it should be,” says lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine physician at SFVAMC. He notes that the prevalence of pain in the last month of life was 60 percent among patients with arthritis and 26 percent among patients without arthritis.
“This research tells us that physicians should anticipate that pain will increase among their elderly and dying patients, assess their patients for pain frequently, and prescribe appropriate pain medications at appropriate levels,” says Smith, who is also an assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco.
Smith recommends that physicians regularly assess and treat pain in their older patients with chronic diseases who are not obviously nearing death. “In other words,” he says, “pain management is not just for hospice patients.” The study appeared in the November 2, 2010 issue of the “Annals of Internal Medicine.”
The authors analyzed data from interviews conducted with 4,703 men and women age 50 and older who died while enrolled in the Health and Retirement Study, an ongoing nationally representative longitudinal study of health, retirement, and aging sponsored by the National Institute on Aging. The interviews were conducted during each participant’s last 24 months of life.
“As physicians, we need to recognize the high burden of pain among our older patients,” says Smith.
He notes that previous studies have indicated that older adults are less likely than other patients to be referred to specialty pain clinics. Based on those studies and on the current study, he says, “I would recommend that clinicians strongly consider referring their older patients to pain clinics or palliative care clinics.”
Co-authors of the study were Irena Stijacic Cenzer, MA, of UCSF, Sara J. Knight, PhD, of SFVAMC and UCSF, Kathleen A. Puntillo, RN, DNSc, of UCSF, and Eric Widera, MD, Brie A. Williams, MD, W. John Boscardin, PhD, and Kenneth E. Covinsky, MD, MPH, of SFVAMC and UCSF.
The study was supported by funds from the National Institute on Aging, the National Center for Research Resources, the National Institute on Musculoskeletal and Skin Diseases, and the National Palliative Care Research Center. Some of the funds were administered by the Northern California Institute for Research and Education.
NCIRE – The Veterans Health Research Institute - is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
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