Managing Pain in the Elderly

Abstract

Edited by Debra K. Weiner, Keela Herr and Thomas Rudy Published by Springer Publishing Company, New York, 2002 390 pages, $49.95 (Hardcover) An interesting dichotomy recognized in both the fields of pain and geriatrics has been that while pain is highly prevalent in elderly people, discussion of this important health care concern has been largely absent in both the fields of geriatrics and pain management. Efforts in the past five to ten years have begun to address this gap through the creation of documents by key organizations such as the International Association for the Study of Pain and the American Geriatric Society. Publication of the text, Persistent Pain in Older Adults, is a significant contribution and does commendable work in addressing pain in older people in a way that should impress both the pain community as well as the world of geriatrics. From the perspective of geriatrics, the authors have synthesized some of the most important geriatric perspectives including a strong statement about unique issues in older adults by Dr. Stephen Harkins. This is complemented by very strong sections on comprehensive interdisciplinary assessment and treatment plans. The text also focuses clearly on some aspects of geriatric care which greatly influence pain management in the elderly. Included are a superb chapter on functional assessment and outcomes, discussion of muscoloskeletal disorders, and an excellent discussion of exercise prescription. The text should be commended for being interdisciplinary in approach and presenting a comprehensive approach to care. The discussion of psychosocial issues and cognitive behavioral therapy provides a clear understanding of treatment as well as clinical application. Pharmacologic management is divided into chapters addressing both non-invasive and invasive modalities. A very unique and well-written chapter addresses complementary and alternative medicine modalities. Professionals in Geriatrics will find the text extremely valuable in integrating pain management content within a geriatric curriculum and clinical settings. The global discussion of functional assessment and outcomes is mirrored by a chapter on persistent pain and neuropsychological function. A general thrust of the text is the term “persistent pain” reflecting recent thinking by the geriatric pain community and transcending general classifications of malignant and non-malignant pain. An additional strong section is a chapter on pain and suffering in older adults approaching the end of life which does a commendable job of recognizing the extent of pain across all life-threatening diseases in the elderly. A final extremely valuable resource is a chapter on educating practitioners about managing pain in older adults. The text is a collage of strengths which include generous use of tables and figures capturing research to date in this area, as well as numerous case examples for clinical application. Cases at the conclusion of each chapter apply the content and include helpful discussion sections. Individuals outside of the realm of geriatric pain management who would read this book will likely assume that the topic of pain in the elderly is at the core of our knowledge, literature and quality care. This text contributes a lot to bridge the gap between what should be and what has been in the field of pain in the older generation.