Pain in the Elderly The effects of aging on pain sensation, perception, and behavior are not well established.59 Findings from studies on pain in human aging are conflicting, partly because of inconsistent research methods and ambiguous research definitions of pain.60 Some notable consistencies have been found, however. Compared with younger adults, elderly persons rely more on second pain (C fiber) than on first pain (A fiber). This difference means that older adults are more likely to describe a painful injury or stimulus as burning (slower C fiber second pain) rather than as sharp or pricking (faster A fiber first pain).61,62 Another well-documented finding in the elderly is a slower response time to pain.58,59,63

No evidence exists that pain intensity lessens with age. Pain as a sensory process does not mimic other senses, such as hearing and sight, which gradually diminish with normal aging.56 Altered reactions to painful events may be due to loss of communications skills, cognitive abilities, or the failure of basic reflexes due to aging. Additionally, pain in the elderly may be manifested as something other than pain, such as delirium. Referred pain may be atypical in the elderly, as in silent (painless) myocardial infarction. Although this lack of referred pain is a clinical problem, no definitive evidence exists of the relationship between age and silent myocardial infarction.

Assessment and Treatment of Pain Pain management in critically ill patients can be challenging. For a variety of reasons, critically ill patients may be unable to verbalize, or they may not fully communicate the nature of their pain. Patients and health care providers may assume that treatment with opioid analgesics can lead to addiction. Despite efforts to relieve pain, harmful physiological effects can ensue, including inadequate sleep, exhaustion, disorientation, anxiety, tachycardia, increased myocardial oxygen demand, immunosuppression, and increased catabolism.64-67 Recognition of pain 44 CRITICALCARENURSE Vol 28, No. 6, DECEMBER 2008 Downloaded from

Painful stimuli can be triggered by a variety of conditions or treatments, such as incisions, drains, ischemia, inflammation, edema, and indwelling invasive and noninvasive catheters, and by a patients previous experiences with painful stimuli. 0 1 2 3 4 NO HURT HURTS LITTLE BIT HURTS LITTLE MORE HURTS EVEN MORE HURTS WHOLE LOT