Acute and chronic pain in geriatrics: clinical characteristics of pain and the influence of cognition

Abstract

Objective: This study aimed to identify which of the well-known characteristics of chronic pain patients are seen even in older patients with multiple comorbidities and considerable functional impairments and how cognition influences patients' reports of acute and chronic pain.

Design: A cross-sectional study.

Setting: Inpatients of acute and rehabilitation wards of a German geriatric hospital.

Patients: Patients with acute (N=36) or chronic (N=55) nonmalignant pain.

Measurements: A comprehensive assessment was conducted, including a structured pain interview and pain assessments using Folstein's mini-mental state (MMS) examination, the Clock Drawing Test (CDT), a short form of Yesavage's Geriatric Depression Scale (GDS), and Spielberger's State-Trait Anxiety Inventory (STAI). The Barthel Index was used to measure the activities of daily living (ADL) at admittance and discharge.

Results: Geriatric patients with chronic pain described more pain sites, used a larger number of pain descriptors, used more analgesics at discharge, and reported both a lower degree of pain reduction during therapy and a lower reduction of disability during hospital stay than did acute pain patients. Anxious and depressive symptoms and difficulty falling asleep tended to be higher in chronic pain patients than in acute pain patients. Cognitively impaired patients described the location of their acute pain as similar to patients with chronic pain and as less precise than did cognitively less-impaired patients. Report of pain intensity and in improvement in the ADL measure were independent of cognitive status.

Conclusions: Geriatric inpatients with chronic pain differ from acute pain patients in pain description, pain reduction during treatment, use of analgesics, and emotional distress. Cognitive impairment seems to change the ability to localize acute pain. In our study, the perception of pain intensity was independent of cognition. Because of the small sample size, further studies are needed to confirm these findings. Multiprofessional, intense rehabilitation programs for geriatric patients with chronic pain are considered of prime importance.