Pain and Aging: A Call to Those with the Power of Inquiry, the Skills to Teach, and the Desire to Heal

Unlike other medical specialties, geriatric medicine arose not from a unique body of knowledge, but because of the need for one. This “development out of necessity” principle also applies to the field of pain and aging, which is still in its infancy. Geriatrics practitioners have long realized the challenges of treating pain in older adults imposed by their tremendous physical and cognitive heterogeneity. In response to this realization, some have established successful multidisciplinary pain management clinics for older patients [1,2]. Others have highlighted the age-related pain management disparities that exist in multiple settings of care (e.g., emergency rooms, hospitals, outpatient clinics, and long-term care facilities) across multiple disciplines (e.g., physicians and nurses), and for multiple pain disorders (e.g., acute and chronic pain, malignant and nonmalignant pain), so as to spur practitioners into action [3–11]. The American Geriatrics Society has published comprehensive pain management guidelines to help practitioners navigate the sometimes murky waters of pain management for older adults [12]. Practitioners have established the need to advance the field of pain and aging. The time for those interested in investigation to respond to this glaring need is now. While over 4,000 articles related to pain are published annually, less than one percent of these focus on pain and aging. Multiple lines of evidence indicate that older adult pain patients are not simply a chronologically older version of younger pain patients. The article in this inaugural edition of the special section, Pain and Aging, highlights that older adults with chronic pain appear to have a lower burden of psychosocial disruption and a lesser desire for pain medications as a self-management strategy than younger individuals [13]. At the same time, the burden of other medical comorbidities and associated polypharmacy in many older adults is higher, as is the risk of social isolation, limited income, and decrements in neuropsychological and physical function [14–16]. Evidence also exists attesting to alterations in neurophysiology associated with pain processing and of pain perception and report in older adults [17,18]. While strides have been made to advance the field of pain and aging, we clearly need the involvement of many more talented investigators from multiple disciplines to adequately tackle its challenges. On behalf of the members of the new special section on Pain and Aging, I invite the readership to think critically about this field and help it to progress. We envision the advancement of the field as a result of the collaboration of all those who interface with older adults—those with the power of inquiry (investigators), the skills to teach (educators), and the desire to heal (practitioners). Evidence-based medical progress that results from the conduct of high-quality empiric research is an arduous and time-consuming process, and is not the only way to make valuable contributions to the field. We therefore encourage submission of a broad variety of manuscripts in addition to those that report the results of clinical investigation—for example, timely reviews of topics for which important progress has been made and for which recent thoughtful reviews are not available, clinical case series that provide unique insights into the assessment and treatment of older adults with pain, and the results of novel educational methods that have the potential to impact patient outcomes. The vast majority of patients that I care for in the context of a referral-based consultative pain management program for older adults are referred from primary practitioners who are genuinely trying to improve the quality of their patients' lives. Many have been unsuccessful in their efforts to do so because they have been equipped with inadequate tools. Their tools are inadequate because the knowledge that forms the basis of these tools has not been provided. The knowledge has not been provided either because it has not been taught or because the rigorous investigation needed to substantiate this knowledge has not been performed. Pain in community-dwelling older adults has been found to predict self-rated health [19] which, in turn, predicts morbidity and mortality [20–24]. We often communicate with patients that pain is a “normal part of aging”; we do not prioritize the teaching of evidence-based pain evaluation and management practices to trainees; and rigorous investigations related to pain and aging are sparse. Should these practices be classified as examples of benign neglect or are our actions, in fact, more egregious? Between 2010 and 2030, it is estimated that those aged 65 years and above will increase by 75%, while those under age 65 years will increase by only 6.5%[25]. The proportion of Americans aged 85 years and above is expected to steadily increase and so, too, the burden of associated frailty and functional decline. To the extent that chronic pain contributes to functional compromise [2,26–28], the need for those with the power of inquiry, the skills to teach, and the desire to heal to rise and address the pain that older adults routinely experience is becoming ever more pressing … Are you out there?