Summary: A higher rate of pain in older adults is associated with much worse physical and mental health. New data suggests persistent pain is more common in older adults than thought. It appears that more than one-third of adults older than 65 live with persistent pain. Another one-third live with pain that comes and goes. That means less than one-third of older adults are fairly pain-free.
Pain is the most common reason people seek medical care. Estimates vary, but studies suggest that about one in five Americans is living with chronic pain at any given time. That is pain that lasts for more than three months. In fact, about 5% of adults live with significant pain. This explains why so many adults use opioids to manage pain.
In theory, persistent pain is even worse than chronic pain. It is pain that does not respond well to painkillers. So people with persistent pain keep hurting despite treatment.
When we look at pain numbers, one fact stands out. Persistent pain is much more common in older adults. After all, older adults often live with many physical and mental health problems. Persistent pain can make things worse for them.
Look at how big the problem is. Studies suggest that more than one-third of adults older than 65 years live with persistent pain. Another one-third live with pain that comes and goes. So less than one-third of these adults live a pain-free life. Those are massive numbers. They show the scale of the problem.
Managing pain in older adults is hard because pain and health problems feed each other, both body and mind. Pain may come from a physical illness. But constant pain makes it even harder to recover from physical illness.
In the same way, persistent pain is quite likely to lead to depression and anxiety. It gets more tangled. Mental health problems like depression significantly increase the risk of chronic or persistent pain. That means people with depression are less likely to benefit from painkillers. They keep reporting pain, which may make their mental health even worse.
So a vicious circle forms in older adults. Pain worsens physical and mental health. Physical and mental health problems cause persistent pain. That shows how hard it is to manage persistent pain at this age. These adults need a plan that attacks the problem from several sides at once.
Doctors need to control the pain and, at the same time, manage the physical and mental health problems. Only that kind of multi-dimensional approach can ensure a cure.
Researchers say there is firm evidence that persistent pain greatly raises the risk of depression and anxiety in older adults. People with persistent pain are also more likely to have a heart attack, stroke, or even cancer. And the low mood caused by pain made these people less likely to keep up with self-care, eating, hygiene, and dressing.
Doctors say there is only one piece of good news. Persistent pain does not appear to cause cognitive impairment (trouble with memory and thinking). It also does not seem to raise dementia risk.
Researchers suggest that doctors keep one fact in mind. Persistent pain is extremely common in older adults. Doctors should change how they treat them to match. They must also pay special attention to managing persistent pain. Without that, they cannot expect better results.
Frequently asked questions
How common is persistent pain in older adults?
Far more common than most people think. More than one-third of adults older than 65 live with persistent pain. Another one-third live with pain that comes and goes. That leaves fewer than one in three older adults who are fairly pain-free. For comparison, about one in five Americans of all ages lives with chronic pain at any given time.
What is the difference between chronic pain and persistent pain?
Chronic pain is pain that lasts more than three months. Persistent pain is a harder problem. It does not respond well to painkillers, so the person keeps hurting even during treatment. That is why persistent pain in seniors can’t be handled with a prescription alone. It needs a plan that looks at the whole person, not just the pain.
Can chronic pain cause depression and anxiety in seniors?
Yes. There is firm evidence that persistent pain raises the risk of depression and anxiety in older adults. It works both ways. Depression also raises the risk of chronic pain, and people with depression get less benefit from painkillers. Low mood from pain also makes people less likely to keep up with eating, hygiene, dressing and other self-care.
Does persistent pain lead to dementia?
This is the one piece of good news in the research. Persistent pain does not appear to cause cognitive impairment. It does not seem to raise the risk of dementia either. The bigger risks are elsewhere. People with persistent pain are more likely to have a heart attack, a stroke or even cancer. They are also more likely to struggle with depression and anxiety.
How should persistent pain be treated in older adults?
With a multi-dimensional approach. Pain makes recovery from physical illness harder. Physical and mental health problems feed the pain. So treating one piece at a time keeps the cycle going. The doctor has to control the pain and, at the same time, manage the physical and mental health problems around it. Doctors should plan treatment knowing how common persistent pain is at this age.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
