Chronic pain and neuropathic pain among community-dwelling older adults in primary health care settings

Background Chronic pain is a common reason for primary care consultations in older community-dwelling adults. Chronic pain is often related with multimorbidity and may compromise patient’s independency and quality of life. Neuropathic pain (NP) causes a more severe burden than nociceptive pain in patients. Prognosis of chronic pain and NP in older adults is unknown. As the population is ageing, the cost and impact of chronic pain are becoming increasingly significant. Objective The focus of this study was to map the occurrence, characteristics and consequences of chronic pain and neuropathic pain in community-dwelling older adults in three age groups (75, 80 and 85 year olds). Methods Independently living older adults were screened for chronic pain during preventive home visits in 2009-2013 in Kirkkonummi, Finland. Patients with chronic pain (duration > 3 months) with average pain intensity and / or interference of > 4 on the NRS 0-10 scale during the week prior to the visit were invited to participate in the study. During the preventive home visits, 106 patients were recruited to the study. During the clinical study visit, a nurse interviewed the patients regarding their pain. The geriatrician then performed a clinical evaluation. One-year postal follow-up survey was conducted afterwards. Results Based on the data collected during the preventive home visits, older adults with chronic pain rated their health and mobility worse, and felt sadder, lonelier and more tired than those living without chronic pain. However, older adults with chronic pain rated their life satisfaction similarly to those without chronic pain. Most of the participants had more than one pain state, and the worst pain in 83% was musculoskeletal. The worst pain was purely nociceptive in 58% and combined nociceptive and NP or purely NP in 40% of participants. Regular pain medication, most commonly paracetamol or NSAIDs, were used by 77%. Only a fifth of the patients with NP were taking recommended medication. Use of non-pharmacological treatments was also common; 75% named at least one non-pharmacological method to alleviate pain. Chronic pain did not compromise participant independence in the one-year follow-up. Conclusions Chronic pain is often a combination of multiple conditions in community-dwelling older adults. Subjective health and mobility are impacted and worsened in those with chronic pain, however life satisfaction remains similar to those without pain.