Chronic and long-term pain was the topic for the November Round Table Discussion Group. We used as a reference a 2012 article in the Journal of Applied Gerontology. The attempt in this qualitative research was to describe responses and adaptations to living with long-term pain. I found it helpful, if a little reductive, to describe reactions to pain as falling into one of four different response categories. According to the analysis of the in-depth interviews people either ignored, struggled, adjusted or resigned themselves to their pain conditions.
The discussion began with the case study of an 81 year old woman, living in supported housing, who complains continually of pain to the resident services coordinator. The resident has not accepted any suggestions for alternative therapies or mental health counseling and has denied wanting to engage in any social activities. Recognizing that a woman presenting like this is difficult from a clinical perspective, recommendations from the group were to first acknowledge and validate the pain and then suggested that reported pain is often depression in disguise. Additionally, complaining of pain can be a convenient and acceptable attention getting behavior. This woman has become socially isolated in her building and so engages the resident services coordinator instead – who has been a willing and attentive listener.
The discussion continued by recognizing some weaknesses in the research. Although it went beyond simply trying to quantify pain and gave a non-judgmental description of behaviors, the research lacked a developmental or a longitudinal analysis. It would have been important to know if a person’s reaction to pain changes over time depending on the etiology of the pain or if pain reaction changes with age. In an effort to categorize people’s responses to pain, it ended up being too rigid. For instance at age 60 is one more likely to ignore the pain but by age 75 or 90 might one’s tolerance change for accepting or adjusting to the pain. One woman in the study who was labeled as resigned to her pain and expressed a wish to die, may be expressing a perfectly acceptable response at age 90 recognizing that her life, in general, not specifically because of the pain, was nearing an end. Rather than strict categories it is critical to understand that pain can be fluid, on a continuum and variable. Pain can change on a daily basis, even hourly – someone may struggle in the morning upon waking up but be more than able to ignore it by midday.
Even though the categories and labels were rigid and did not explicate the fluidity of responses to pain I thought it was helpful to describe more deeply the variety of pain reactions. Certainly the ignore and the struggle response were the most adaptive and allowed people to continue to participate in their lives. The authors point out that individuals in the adjust group may have assimilated their pain more than the ignore or struggle group, but they comment that in any case, all responses are a negotiation with oneself. So much of aging is a negotiation and a re-conceptualizing of oneself and one’s abilities and limitations.
Does understanding about living with long-term pain provide any insight into a broader context about normal aging? The description of the group of individuals who struggle to manage their pain expressed the idea that they vacillate between hope and despair. This seems like a good metaphor for the whole process of aging. As one ages and approaches being in the oldest old cohort, one can feel alternatively hopeful and positive about the life and relationships one has experienced. And at the same time, feel despondent and sad about the leaving. As clinicians, family members and caregivers, it seems important to give voice to the ambivalence.
The Round Table Discussion Group meets monthly for an interdisciplinary conversation with experienced professionals in the field of aging. Each conversation uses one or two journal articles as reference points. The articles read for this discussion were:
- Older Adults’ Ways of Dealing With Daily Life While Living With Long-Term Musculoskeletal Pain at Home, Catharina Gillsjö, Donna Schwartz-Barcott, Ingrid Bergh, and Lars Owe Dahlgren, Journal of Applied Gerontology, 31(5) 685-705, 2012