Pain Is Frequent in the Last Two Years of Life

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Researchers at the San Francisco VA Medical Center carried out a study which reveals that pain, especially the one caused by arthritis, is very common in the last two years of an old person's life.

Pain in older people should not be ignored, and this is actually the first study to assess the frequency of pain that the elderly experience during the last two years of their lives.

For the study, the authors analyzed data from interviews conducted for the Health and Retirement Study, which included 4,703 men and women age 50 and older who died while enrolled in the program.

The interviews were taken during each participant’s last 24 months of life.

The results showed that 46 percent of study participants had moderate to severe pain during their final four months of life.

The scientists also found that over 25% of the patients had moderate to severe pain during the last two years of life, and that the biggest single predictor of this pain was arthritis, more than any other diseases, including cancer.

Lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine physician at SFVAMC stresses that “the impact of arthritis on the experience of pain among older adults has not been recognized to the extent it should be.”

And as a support to his statement he explains that from all patients experiencing pain in the last month of their lives, 60% suffered from arthritis and only 26% did not.

“This research tells us that physicians should anticipate that pain will increase among their elderly and dying patients, assess their patients for pain frequently, and prescribe appropriate pain medications at appropriate levels,” says Smith.

Smith, who is also an assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco, strongly suggests that physicians regularly evaluate and treat the pain of their older patients with chronic diseases who are not obviously nearing death.

“In other words, pain management is not just for hospice patients,” he says, “[and] as physicians, we need to recognize the high burden of pain among our older patients.”

This study was possible thanks to funding from the National Institute on Aging, the National Center for Research Resources, the National Institute on Musculoskeletal and Skin Diseases, and the National Palliative Care Research Center.

The research appears today in the Annals of Internal Medicine.

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