Older Patients Often Under-Report Pain

By Jane Farrell

Older post-operative patients may experience pain but not admit it as often as younger patients, according to new research presented at this year’s Euroanaesthesia meeting in Geneva.

Because of that, the researchers concluded, it may be better to ask patients directly about how well they are functioning post-operatively rather than about how much pain they are feeling.

At least half of surgical patients suffer from moderate to severe pain after common operations. However, individual perceptions of pain intensity, impairments caused by pain, and effectiveness of pain relief differ depending on the type of surgery, medication, gender, and age. Previous studies have shown that patient-reported maximum pain decreases with increasing age.

In this study, Claudia Weinmann, Dr Marcus Komann and Prof. Winfried Meissner from Jena University Hospital in Germany wanted to determine whether these findings could be confirmed by international registry data, and also whether age influences other outcomes like pain-related functional impairment.

Using data from the PAIN OUT* registry–an international acute pain registry and research project that collects patient-reported outcome data on day 1 after surgery– Meissner and his team examined both pain intensity and interference of pain in physical activity (also known as functional impairment) in 2,390 patients who underwent a total knee replacement in 54 hospitals around the world between February 2010 and November 2016.

The results showed a clear trend of reported pain scores decreasing with increasing age. However, scores for functional impairment – i.e. how much the pain actually affected physical activity – did not decrease with increasing age.

The authors conclude: “Our study confirms that the older the patients, the lower their reported maximum pain levels. However, elderly patients do not report less functional impairment caused by pain. As functional impairment is a more clinically relevant factor for postoperative recovery pain intensity, these findings suggest that elderly patients might tend to underreport their pain levels, and that asking about functional impairment might be a better tool for pain assessment.”

They add: “Is it more likely that older patients do not report pain for ‘social’ reasons — for example, they think pain is normal or they have to bear it without complaint – and thus the levels of pain are underreported.”