Susanna Rapo-Pylkkö1,2, Maija Haanpää3,4, Helena Liira5,6. 1. Kirkkonummi Health Center, Virkatie 1, 02400, Kirkkonummi, Finland. susanna.rapo-pylkko@pp.fimnet.fi. 2. Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. susanna.rapo-pylkko@pp.fimnet.fi. 3. Mutual Insurance Company Etera, Helsinki, Finland. 4. Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. 5. Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. 6. General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Australia.
Abstract
BACKGROUND: Neuropathic pain is more common among older people than in the general population, and the efficacy of medical treatment often remains unsatisfactory. OBJECTIVE: The aim of this study was to assess the presence, diagnostic certainty, etiology and treatment of neuropathic pain in community-dwelling older people with chronic pain. METHODS: Independently living older people aged 75, 80 and 85 years subject to communal preventive home visits with chronic pain were invited to a clinical pain examination by a geriatrician. RESULTS: Overall, 106 patients consented to participate in the clinical study. Neuropathic pain was diagnosed in 51 (48%) patients, with 75% of pain states definite and 25% probable neuropathic pain. The most common etiology was degenerative disease of the spinal column causing radiculopathy. At the study visit, 11 patients (22% of neuropathic pain patients) were receiving medication that was demonstrated to be effective against neuropathic pain. The geriatrician recommended a trial of a new medicine for 17 patients, but only six continued the medication going forward. CONCLUSIONS: Neuropathic pain was surprisingly common in our cohort. Finding effective pain medication is challenging due to comorbidities, possible side effects, and vulnerability in older age. Other pain management methods should be considered.
BACKGROUND:Neuropathic pain is more common among older people than in the general population, and the efficacy of medical treatment often remains unsatisfactory. OBJECTIVE: The aim of this study was to assess the presence, diagnostic certainty, etiology and treatment of neuropathic pain in community-dwelling older people with chronic pain. METHODS: Independently living older people aged 75, 80 and 85 years subject to communal preventive home visits with chronic pain were invited to a clinical pain examination by a geriatrician. RESULTS: Overall, 106 patients consented to participate in the clinical study. Neuropathic pain was diagnosed in 51 (48%) patients, with 75% of pain states definite and 25% probable neuropathic pain. The most common etiology was degenerative disease of the spinal column causing radiculopathy. At the study visit, 11 patients (22% of neuropathic painpatients) were receiving medication that was demonstrated to be effective against neuropathic pain. The geriatrician recommended a trial of a new medicine for 17 patients, but only six continued the medication going forward. CONCLUSIONS:Neuropathic pain was surprisingly common in our cohort. Finding effective pain medication is challenging due to comorbidities, possible side effects, and vulnerability in older age. Other pain management methods should be considered.
Authors: Kenneth E Schmader; Ralf Baron; Maija L Haanpää; John Mayer; Alec B O'Connor; Andrew S C Rice; Brett Stacey Journal: Mayo Clin Proc Date: 2010-03 Impact factor: 7.616
Authors: Robert H Dworkin; Christopher J Panarites; Edward P Armstrong; Daniel C Malone; Sissi V Pham Journal: Pain Date: 2012-02-21 Impact factor: 6.961
Authors: Marco D DiBonaventura; Alesia Sadosky; Kristen Concialdi; Markay Hopps; Ian Kudel; Bruce Parsons; Joseph C Cappelleri; Patrick Hlavacek; Andrea H Alexander; Brett R Stacey; John D Markman; John T Farrar Journal: J Pain Res Date: 2017-11-01 Impact factor: 3.133