Advertisement

Non-pharmacological Management of Pain in the Elderly

  • Carol Mackintosh-Franklin
Chapter
Part of the Perspectives in Nursing Management and Care for Older Adults book series (PNMCOA)

Abstract

Pain in the elderly is an increasing problem with increasing life expectancy resulting in many people living for longer with a range of age-related debilitating and painful conditions. Management of pain in the elderly can be complex due to increasing fragility, cognitive impairment and the presence of comorbidities and polypharmacy. Non-pharmacological methods of pain relief would appear to offer a solution to many of these problems. Overall the evidence for the effective use of many non-pharmacological therapies in pain management for the elderly is limited. Most effective measures appear to be those which support self-help, those which provide distraction and promote exercise and the use of superficial heat/cold. There is limited evidence to support the use of most complementary and alternative medicines (CAMs) including dietary supplements, and the role of psychological therapy is limited to improvements in mood states such as anxiety and depression. However due to the low incidence of adverse events, any non-pharmacological therapy which is perceived as offering some relief from suffering by the individual may have personal value.

Keywords

Pain Elderly Non-pharmacological Complementary/alternative therapies Exercise Thermotherapy Psychological therapy Self-help 

References

  1. Ali V. Self-treatment strategies. In: Banks C, Mackdrodt K, editors. Chronic pain management. London: Whurr; 2005.Google Scholar
  2. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: why and when. Best Pract Res Clin Rheumatol. 2015;29:120–30.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Arankalle K, Wardle J, Nair PMK. Alternate hot and cold application in the management of heel pain: a pilot study. Foot. 2016;29:25–8.CrossRefGoogle Scholar
  4. Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs. 2004;5(3):97–104.CrossRefPubMedGoogle Scholar
  5. Baird CL, Murawski MM, Wu J. Efficacy of guided imagery with relaxation for osteoarthritis symptoms and medication intake. Pain Manag Nurs. 2010;11(1):56–65.CrossRefPubMedGoogle Scholar
  6. Brismee JM, Paige RL, Boatright JD, Hager JM, McCaleb JA, Quintela M, Feng D, Xu KT, Shen CL. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomised controlled trial. Clin Rehabil. 2007;29:99–111.CrossRefGoogle Scholar
  7. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18(3):22–33.Google Scholar
  8. Brown ST, Kirkpatrick MK, Swanson MS, McKenzie IL. Pain experience of the elderly. Pain Manag Nurs. 2011;12(4):190–6.CrossRefPubMedGoogle Scholar
  9. Bruckenthal P, Mariono MA, Snelling L. Complementary and integrative therapies for persistent pain management in older adults. J Gerontol Nurs. 2016;42(12):40–8.CrossRefPubMedGoogle Scholar
  10. Bruyere O, Altman RD. Efficacy and safety of Glucosamine Sulfate in the real management of osteoarthritis; evidence from real life trials and surveys. Semin Arthritis Rheum. 2016;45(4):S12–7.CrossRefPubMedGoogle Scholar
  11. Chen B, Shan H, Chung M, Lin X, Zhang M, Pang J, Wang C. Chinese herbal bath therapy for the treatment of knee osteoarthritis: meta-analysis of randomised controlled trials. Evid Based Complement Alternat Med. 2015;2015:949172.PubMedPubMedCentralGoogle Scholar
  12. Cino K. Aromatherapy hand massage for older adults with chronic pain living in long-term care. J Holist Nurs. 2014;32(4):304–13.CrossRefPubMedGoogle Scholar
  13. Cooil J. Self-treatment strategies. In: Banks C, Mackdrodt K, editors. Chronic pain management. London: Whurr; 2005.Google Scholar
  14. Dallob RA, Lopez-Chertuidi C, Rose T. Psychological Perspectives. In: Banks C, Mackdrodt K, editors. Chronic pain management. London: Whurr; 2005.Google Scholar
  15. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioural therapy for individuals with chronic pain. Am Psychol. 2014;69(2):153–66.CrossRefPubMedGoogle Scholar
  16. Fransen M, McConnell S, harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376.PubMedGoogle Scholar
  17. Galvin R, Cousins G, Boland F, Motterlini N, Bennett K, Fahey T. Prescribing patterns of glucosamine in an older population: a national cohort study. BMC Complement Altern Med. 2013;13:316–22.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Geilser CC, Cheung C. Complementary/alternative therapies use in older women with arthritis: information sources and factors influencing dialog with health care providers. Geriatr Nurs. 2015;16:15–20.Google Scholar
  19. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;1:CD011279.PubMedGoogle Scholar
  20. Giacobbi PR, STabler ME, Stewart J, Jaeschke AM, Siebert JL, Kelley GA. Guided imagery for arthritis and other rheumatic diseases: a systematic review of randomised controlled trials. Pain Manag Nurs. 2015;16(5):792–803.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Giemza C, Matczack-Giemza M, Ostrowska B, Biec E, Dolinski M. Effect of cryotherapy on the lumber spine in elderly men with back pain. Ageing Male. 2014;17(3):183–8.CrossRefGoogle Scholar
  22. Giemza C, Matczack-Giemza M, De Nardi M, Ostrowska B, Czech P. Effect of frequent WBC treatments on the back pain therapy in elderly men. Ageing Male. 2015;18(3):135–42.CrossRefGoogle Scholar
  23. Guetin S, et al. The effects of music intervention in the management of chronic pain. Clin J Pain. 2012;28(4):329–37.CrossRefPubMedGoogle Scholar
  24. Hall A, Cosey B, Richmond H, Thompson J, Ferreria M, Latimer J, Maher CG. Effectiveness of Tai Chi for chronic musculoskeletal pain conditions: updates systematic review and meta-analysis. Phys Ther. 2017;97(2):227–38.CrossRefPubMedGoogle Scholar
  25. Hinman RS, McCory P, Pirotta M, Reif I, et al. Acupuncture for chronic knee pain. A randomised clinical trial. J Am Med Assoc. 2014;312(13):1313–22.CrossRefGoogle Scholar
  26. Hochberg MC, et al. Combined chondroitin sulfate and glucosamine for painful knee osteoarthritis; a multicentre, randomised, double-blind, non-inferiority trail versus celecoxib. Ann Rheum Dis. 2016;75:37–44.CrossRefPubMedGoogle Scholar
  27. Institute of Medicine (US) committee on advancing pain research, care and education. Relieving pain in America: a blueprint for transforming prevent, care, education and research. Washington DC: National Academic Press; 2011.Google Scholar
  28. Karttunen NM, Turunen J, Ahonen R, Hartikainen S. More attention to pain management in community dwelling older person with chronic musculoskeletal pain. Age Ageing. 2014;43:845–50.CrossRefPubMedGoogle Scholar
  29. Keefe FJ, Porter L, Somers T, Shelby R, Wren AV. Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth. 2013;111(1):89–94.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Korban EA, Uyar M, Eyigor C, Yont GH, Celik S, Khorshid L. The effects of music therapy on pain in patients with neuropathic pain. Pain Manag Nurs. 2014;15(1):306–24.CrossRefGoogle Scholar
  31. McCaffery M, Pasero C. Pain: clinical manual. St. Louis: Mosby; 1999.Google Scholar
  32. McFeeters S, Pront L, Cuthbertson L, King L. Massage, a complementary therapy effectively promoting the health and well-being of older people in residential care settings; a review of the literature. Int J Older People Nursing. 2014;11:266–83.CrossRefGoogle Scholar
  33. Morone NE, Lynch CS, Greco CM, Tindle HA, Weiner DK. I felt like a new person. The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. J Pain. 2008;9(9):841–8.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Nash VR, Ponto J, Townsend C, Nelson P, Bretz MN. Cognitive behavioural therapy, self-efficacy, and depression in persons with chronic pain. Pain Manag Nurs. 2013;14(4):e236–43.CrossRefPubMedGoogle Scholar
  35. Nasiri A, Mahmodi MA, Nobakht Z. Effect of aromatherapy massage with lavender essential oil on pain patients with osteoarthritis of the knee: a randomised controlled clinical trial. Complement Ther Clin Pract. 2016;25:75–80.CrossRefPubMedGoogle Scholar
  36. National Health Service. Complementary and Alternative Medicine. 2016. https://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/complementary-alternative-medicines.aspx. Accessed Nov 2017.
  37. National Institute for Health and Care Excellence. Low back pain. Early management of persistent non-specific low back pain. 2009. https://www.nice.org.uk/guidance/CG88. Accessed Nov 2017.
  38. National Institute for Health and Care Excellence. Osteoarthritis: care and management. NICE. 2014. nice.org.uk/guidance/cg177.
  39. National Institute of Health Care Excellence. Depression in adults with a chronic physical health problem: recognition and management. Clinical guideline CG91. 2009. https://www.nice.org.uk/guidance/cg91.
  40. National Institute of Health Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. 2016. https://www.nice.org.uk/guidance/qs155/.
  41. Nelson NL, Churilla JR. Massage therapy for pain and function in patients with arthritis. Am J Phys Med Rehabil. 2017;96(9):665–72.CrossRefPubMedGoogle Scholar
  42. Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomised controlled trial of the effects of chair yoga on pain and physical function among community dwelling older adults with lower extremity osteoarthritis. Am Geriatr Soc. 2017;65:592–7.CrossRefGoogle Scholar
  43. Patel NK, Akkihebbalu S, Espinoza SE, Chiodo LK. Perceptions of community-based yoga intervention for older adults. Act Adapt Ageing. 2011;35:151–63.Google Scholar
  44. Petrosfsky JS, Laymon MS, Alshammari FS, Lee H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomised controlled trial. J Strength Cond Res. 2016;30(11):3107–15.CrossRefGoogle Scholar
  45. Platts-Mills TF, Hoover MV, Burgh ET, LaMantia MA, Davis S, Weaver MA, Zimmerman S. Development and validation of a brief interactive educational video to improve outpatient treatment of older adults acute musculoskeletal pain. J Am Geriatr Soc. 2016;64(4):880–1.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Porcheret M, Jordan K, Jinks C, Croft P. Primary care treatment of knee pain – a survey of older adults. Rheumatology. 2007;46:1694–700.CrossRefPubMedGoogle Scholar
  47. Provenza JR, Shinjo SK, Silva JM, Peron CRGS, Rocha FAC. Combined glucosamine and chondroitin sulfate, once or three times daily provides clinically relevant analgesia in knee osteoarthritis. Clin Rheumatol. 2015;34:1455–62.CrossRefPubMedGoogle Scholar
  48. Quach J, Lee JA. Do music therapies reduce depressive symptoms and improve QOL in older adults with chronic disease? Nursing. 2017;47(6):58–63.CrossRefPubMedGoogle Scholar
  49. Reid MC, Papaleontious M, Ong A, Breckman R, Wethington E, Pillemer K. Self-management strategies to reduce pain and improve function among older adults in community settings: a review of the evidence. Pain Med. 2008;9(4):409–24.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Reid CM, Shengelia R, Parker SJ. Pharmacologic management of osteoarthritis-related pain in older adults. Am J Nurs. 2012;31(2):109–14.Google Scholar
  51. Runhaar J, et al. Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank. Ann Rheum Dis. 2017;76:1862–9.CrossRefPubMedGoogle Scholar
  52. Rutjes AW, Nuesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M. Transcutaneous electrical stimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;7(4):CD002823.Google Scholar
  53. Sawitzke AD, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2 year results from GAIT. Ann Rheum Dis. 2010;69:1459–64.CrossRefPubMedPubMedCentralGoogle Scholar
  54. Schiller J, Korallus C, Bethge M, Karst M, Schmalhofer ML, Gutenbrunner C, Fink MG. Effects of acupuncture on quality of life and pain in patients with osteoporosis – a randomised controlled trial. Arch Osteoporos. 2016;11(34):1–10.Google Scholar
  55. Schofield P. Pain management in older adults. Med Older Adults. 2016;45(1):41–5.Google Scholar
  56. Schreiber KL, et al. Distraction analgesia in chronic pain patients. Anaesthesiology. 2014;121(6):1292–301.CrossRefGoogle Scholar
  57. Shengelia R, Parker SJ, Ballin M, George T, Reid MC. Complementary therapies for osteoarthritis: are they effective? Pain Manag Nurs. 2013;14(4):274–88.CrossRefGoogle Scholar
  58. Simon CB, Riley JL, Fillingim RB, Bishop MD, George SZ. Age group comparisons of TENS response among individuals with chronic axial low back pain. J Pain. 2015;16(12):1268–79.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Takai Y, Yamamoto-Mitani N, Okamoto Y, Kyama K, Honda A. Literature review of pain prevalence among older residents of nursing homes. Pain Manag Nurs. 2010;11(4):209–23.CrossRefPubMedGoogle Scholar
  60. Taylor P, Pezzullo L, Grant SJ, Bensoussan A. Cost-effectiveness of acupuncture for chronic nonspecific low back pain. Pain Pract. 2013;14(7):599–606.CrossRefPubMedGoogle Scholar
  61. The British Geriatric Society. Guidance on the management of pain in older people. Age Ageing. 2013;42:i1–57.CrossRefGoogle Scholar
  62. The House of Lord. Select Committee on Complementary and Alternative Therapies. 2000. https://publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12302.htm. Accessed Nov 2017.
  63. Tobias KE, Lama SD, Parker SJ, Henderson CR, Nickerson AJ, Carrington Reid M. Meeting the public health challenge of pain in later life: what role can senior centers play? Pain Manag Nurs. 2014;15(4):760–7.CrossRefPubMedGoogle Scholar
  64. Tsai PF, Chang JY, Beck C, Kuo YF, Keefe FJ. A pilot cluster randomised trial of a 20 week tai chi program in elders with cognitive impairment and osteoarthritic knee: effects on pain and other health outcomes. J Pain Symptom Manag. 2013;45(4):660–9.CrossRefGoogle Scholar
  65. Tse M, Leung R, Ho S. Pain and psychological well-being of older persons living in nursing homes: an exploratory study in planning patient centred interventions. J Adv Nurs. 2012;68(2):312–21.CrossRefPubMedGoogle Scholar
  66. Tse MMY, Tan SK, Wan VTC, Vong SKS. The effectiveness of physical exercise training in pain, mobility and psychological well-being of older persons living in nursing homes. Pain Manag Nurs. 2014;15(4):778–88.CrossRefPubMedGoogle Scholar
  67. Van den Dolder A, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain; a systematic review with meta-analysis. Br J Sports Med. 2014;48:1216–26.CrossRefPubMedGoogle Scholar
  68. Wilson M, Roll JM, Corbett C, Barbosa-Leiker C. Empowering patients with persistent pain using an internet based self-management program. Pain Manag Nurs. 2015;16(4):503–14.CrossRefPubMedGoogle Scholar
  69. Wirth JH, Hudgins JC, Paice JA. Use of herbal therapies to relieve pain: a review of efficacy and adverse effects. Pain Manag Nurs. 2005;6(4):145–67.CrossRefPubMedGoogle Scholar
  70. Yang S, Dube CE, Eaton CB, McAlindon TE, Lapan KL. Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis. Clin Ther. 2013;35(11):1690–702.CrossRefPubMedGoogle Scholar
  71. Yildrum N, Ulusoy MF, Bodur H. The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. J Clin Nurs. 2010;19:1113–20.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Nursing, Midwifery and Social WorkUniversity of ManchesterManchesterUK

Personalised recommendations