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Senior Citizens Better At Coping With Chronic Pain
Jan. 24, 2005 – Adults 50 and older are better able
to cope with chronic pain and less prone to suffer associated depression
than are younger adults, a new study suggests.
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And the same “generation gap” pattern exists among
both blacks and whites, though blacks of all ages have previously been
found to experience more pain and more pain-related negative effects
than whites.
The study also finds that in general, blacks scored
higher than whites on measurements of the intensity of their pain,
disability related to their pain, and depression symptoms. This finding
is consistent with past studies on pain that examined racial differences
in chronic pain experience.
“No matter what your color or age, chronic pain
has a major impact on your life and your ability to work or function,”
says the study’s senior author, U-M pain specialist Carmen R. Green,
M.D., who is co-guest editor of the special issue. “Our study suggests
that age is a significant factor across races and ethnicities, and that
the impact of pain may differ even within racial and ethnic groups.”
Green recently was named an inaugural Mayday Pain and Society fellow by
the Mayday Pain Project.
The new study examined detailed data from 5,823
black and white adults treated at the U-M Multidisciplinary Pain Center
over eight years. They were divided into two groups: those under age 50,
and those seniors over age 50.
During their evaluation for pain treatment, the
patients completed standardized questionnaires that assessed their
mental and physical status, as well as the intensity and impact of their
pain, the ability to cope with their pain, sleep and alcohol use
patterns, and symptoms of depression and post-traumatic stress disorder
that can result from painful medical conditions or an incident that
results in chronic and persistent pain. The study was retrospective and
cross-sectional, and it included patients with many chronic pain
conditions.
Within both racial groups, there were significant differences between
the age groups.
Older whites, and older blacks, were better able to
cope with their pain, had less trouble falling asleep, and had fewer
depressive symptoms than younger members of their racial group. Even
after the researchers corrected for differences in the number of months
the patients had lived with their pain, and for differences in gender,
marital status and education, the effects remained.
Why the gap? A combination of generational
characteristics and attitudes, life experiences and age-related health
expectations may be at play, though more research is needed to find out,
say Green and her colleague Tamara Baker, Ph.D., of USF’s School of
Aging Studies. Baker formerly was a postdoctoral fellow at the U-M
School of Public Health’s Center for Research on Ethnicity, Culture and
Health.
“Older people may feel that pain is just something
that you deal with, perhaps because they were raised in a time when pain
was not addressed in the way we deal with it today, or because they feel
that pain is just a normal part of getting older,” says Green, an
associate professor of anesthesiology at the U-M Medical School and
attending physician at the U-M Center for Interventional Pain Medicine.
“But younger people, who may be dealing with job
and family stress in addition to their pain, may experience more
negative effects,” she continues. “They may also have different
expectations about pain treatment and about experiencing chronic pain at
a relatively young age. This is particularly important because the
prevalence of chronic pain is increasing.”
Indeed, recent advances in pain diagnosis and
treatments, and in the training of doctors and nurses to see pain as a
vital sign just like temperature and pulse rate, mean that more patients
are getting effective relief for their chronic pain than ever before.
So, younger people may just expect more from pain treatment than their
elders do.
Green and Baker note that assessing depression
symptoms in people being treated for chronic pain is complicated by a
sort of “chicken and egg” problem: depression itself can cause or
exacerbate vague pain, but it can also be triggered by a stressful event
such as an injury or illness that itself causes pain. It is important to
note, they say, that when a person has chronic pain, other problems such
as depression, anxiety and sleep disturbances often follow.
For blacks, age isn’t the only factor. They are
more likely than whites to have several chronic illnesses associated
with pain, ranging from diabetes to heart disease and arthritis. They
are also more likely to experience increased disability associated with
those diseases.
Numerous studies have shown that blacks and members
of other racial and ethnic minorities are consistently under-treated for
pain across a range of conditions, from cancer and chest pain to acutely
painful conditions like broken bones and chronic lower-back pain.
And Green’s own previous work has also shown that,
regardless of their age, blacks with chronic non-cancer pain from any
source suffered more psychological and physical effects than whites.
Other research by Green and her colleagues has shown that access to pain
care and pain medications can also vary by race and ethnicity. For
instance, pharmacies in neighborhoods with large minority populations
tend not to carry narcotic pain medicines such as morphine.
Green hopes that the new study, and others in the
special issue of Pain Medicine, will continue to draw the attention of
pain researchers and plant the seeds for further research in this area.
“These findings are particularly important when you
consider that pain is estimated to impact more than 100 million
Americans, and will clearly impact independence and successful aging,”
she says.
The new study, by researchers at the University of
Michigan and the University of South Florida, appears in a special issue
of the journal Pain Medicine, published by the American Academy
of Pain Medicine. The issue focuses on the differences in pain, pain
effects and pain treatment that are increasingly being found between
members of different racial and ethnic groups.
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