Researchers aimed to determine the frequency of pain assessments and the extent of pain scores by age for patients undergoing traumatic surgery.
Adult trauma patients between the ages of 18 and 64 exhibited higher pain scores and more frequent pain assessments after surgery than participants over 65, according to data from a JAMA Surgery research letter.1 Authors of the study suggested that older adults reported less pain and at lower frequencies to avoid medical procedures and costs, ultimately with the goal of maintaining sole control of their pain management.
“Poor pain control can limit or prevent participation in rehabilitation both inpatient and after hospitalization. Older adults have been shown to receive inadequate pain management. In a study of pain-related visits to the emergency department, older patients (≥75 years) received less analgesic treatment than middle-aged patients,” wrote authors of the study.
Incorporate these strategies into your pharmacy practice to improve patient outcomes.
While not age-specific, the management of pain has become an increasingly worrying issue within the US. According to CDC statistics from 2019 to 2021, a total of 51.6 million patients reported chronic pain in the US, with 17.1 million experiencing high-impact chronic pain.2 Compounded with rising prescription drug costs and a national opioid crisis spurred on by the prominence of acute pain in the country, pain management has been a mystery clinical experts have tried to solve for decades, if not centuries.
Indeed, due to growing rates of abuse amidst the ongoing opioid epidemic, a fear of prescription medications for treating chronic pain has since entered the psyche of patients living in the US. Overdose death rates peaked in 2015 as opioids like heroin and fentanyl ravaged the streets of almost all 50 US states; Hawaii, Oklahoma, South Dakota, and Utah were the only states that saw no significant changes in their state rates of opioid overdose deaths.3
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Pain is such a prominent issue in US hospitals, but providers have exhibited caution when prescribing their patients medication for the treatment of chronic pain after surgery. In a retrospective cross-sectional study, researchers addressed how often trauma patients receive pain assessments after surgery. They also determined the extent of each patient’s pain and how it varied by age.1
They gathered data from a total of 21,063 trauma patients (mean age, 53 years; 69% men) admitted to Zuckerberg San Francisco Hospital’s trauma center from 2012 to 2022. “We compared frequency of pain assessment and pain score magnitude and variability between older and younger adults in medical-surgical floors, which have a policy with clearly defined pain assessment intervals,” continued authors of the study.
Researchers searched for patient outcomes across 3 populations. They first compared younger adults aged 18 to 64 with older adults over 65. Then, they compared the same group of younger adults with older adults over the age of 75. Researchers also considered characteristics like sex, race and ethnicity, and insurance type.
Compared with both the 65- and 75-and-older groups, younger adults 18 to 64 had significantly higher pain scores, pain assessment frequencies, and pain score variability.
“Our finding of less frequent pain assessments for older adults accords with a study wherein older trauma patients had pain assessed less frequently than hospital protocol. One study suggested that older adults may underreport pain to avoid procedures or maintain agency,” they wrote.1
While issues of chronic pain or abuse of pain therapies can occur in any age group, these study results show that pain management interventions are less prominent among adults over 65. Researchers did not seek specific factors that caused the under-utilization of pain management services, but they suggested further research be conducted regarding pain management within a post-surgical setting.
“Given the importance of pain management after traumatic injury, less frequent pain assessment and lower pain scores may result in less pain management for older adults...Future research could identify factors in differences in reporting pain between hospitalized older and younger patients, and associations of these factors with downstream outcomes, including inpatient pain medication use and post discharge pain,” concluded authors of the study.1
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