Abstract
BackgroundPain is an important issue in end of life care. Although musculoskeletal pain is common in older adults, it is rarely associated with the cause of death and may be overlooked as death approaches. Hence a major target for improving quality of life may be being missed.MethodsThe aim of this study was to systematically search and critically review the literature on musculoskeletal pain at the end of life. Amed, Cinahl, Internurse, Medline, Psych Info, Web of Knowledge and Cochrane review databases were searched for relevant research up to September 2012. The search strategy combined key words expanding the terms ‘palliative’ for population, ‘musculoskeletal’ for exposure, and ‘pain’ for outcome. Predefined inclusion and exclusion criteria were applied.ResultsFive relevant papers and one letter to the editor were found, including case studies and epidemiological research. Current evidence suggests musculoskeletal pain is common in older adults at the end of life and that it can have a substantial impact on individual experience. No information about community based treatment of musculoskeletal pain at the end of life was found.ConclusionPriorities for future research include high quality epidemiological studies to establish the prevalence, natural history, impact, assessment, patient priorities and outcomes associated with musculoskeletal pain in the end of life period, and intervention research that provides an evidence base for treatment.
Highlights
Pain is an important issue in end of life care
The findings present a dichotomy of methods and focus with two epidemiological papers that suggest that musculoskeletal symptoms have a substantial impact at the end of life in the general population and four cases studies showing that musculoskeletal pain can be a significant issue for individuals requiring unusually sophisticated pain control measures including temporary sedation, cordotomy, arthroplasty and very high dose opiates
There is a need for randomised controlled trials to ensure that the treatments are effective and safe within a general population. This systematic search of the literature suggests that musculoskeletal disease is an important issue that can significantly impact on pain in the elderly at the end of life
Summary
Pain is an important issue in end of life care. musculoskeletal pain is common in older adults, it is rarely associated with the cause of death and may be overlooked as death approaches. Most studies of pain and other symptoms at the end of life consider the needs of people with a specific advancing progressive disease [11,12,13], and do not include symptoms associated with co-morbid diseases like arthritis [12], or other common causes of musculoskeletal pain. This is compounded by the dearth of research to inform the treatment of pain in the elderly [5,14]. A recent review of pain management found no well-designed studies of analgesia that focused on elderly patients requiring palliative care [15]
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