Chronic pain is one of the most common conditions healthcare professionals encounter, particularly among older adults.1
- Approximately half of all older adults report experiencing bothersome pain within the last month, and three quarters of these older adults report pain in more than one location.2
- Older adults who are dually eligible for both Medicare and Medicaid in particular have higher rates of chronic pain than adults with all other types of coverage.3
- Despite the high prevalence of chronic pain among older adults, research suggests that chronic pain is often underdetected and undertreated with advancing age.4
- Untreated or ineffectively managed chronic pain can lead to significant health consequences among older adults, including depression, decreased ability to socialize, impaired sleep, increased falls, malnutrition, and decreased quality of life.5
Individuals with intellectual and developmental disability (I/DD) are also at increased risk for chronic pain due to factors such as higher risk of accidental injury, more physical comorbidities (e.g., musculoskeletal disorders in conditions associated with intellectual disability), and reduced access to pain management services.6 As clinicians and health plans help individuals manage pain, it is important to treat pain in a manner that meets the needs and preferences of the people experiencing pain. Resources for Integrated Care has developed resources such as webinars and written briefs to help providers and health plans serving dually eligible individuals identify and treat the pain needs of those they serve.
Complex Pain Management
In treating the complex pain needs of individuals, providers and health plans should adopt pain management strategies that are person-centered, tailored to each individual, and that optimize their health, function, and quality of life.7,8 Experts recommend that complex pain management be integrated, multimodal, interdisciplinary, evidence-based, and individualized, in keeping with the biopsychosocial model of pain.9,10,11 A multimodal pain management approach offers individuals access to a range of therapy options for the most effective combination of services that improves their pain-related function and quality of life.12 Resources for Integrated Care has developed resources that help providers and health plans understand person-centered pain management and the various treatment options for treating complex pain.
7 Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92510/.
8 U.S. Department of Health and Human Services. (2019). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html.
9 National Academies of Sciences, Engineering, and Medicine. (2017). Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press (US); 2, Pain Management and the Intersection of Pain and Opioid Use Disorder. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK458655/.
10 U.S. Department of Health and Human Services. (2019).
11 U.S. Department of Health and Human Services. (2016). National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. Retrieved from: https://www.iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf.
12 Williamson, K., Alikhan, S., Greene, K., Becker, M., & Tewarson, H. (2020). Expanding access to non-opioid management of chronic pain: Considerations for governors. Washington, DC: National Governors Association Center for Best Practices. Retrieved from: https://www.nga.org/wpcontent/uploads/2020/08/NGA_PainManagement.pdf.
Pain in Individuals with IDD
People with I/DD are more likely to experience behavioral and physical health comorbidities, and as a result may be more likely to experience pain.13 Self-reporting is often used to assess pain but people with I/DD can experience challenges with self-reporting pain or exhibit differences in how they express pain.14
There are important considerations for providers when assessing pain in people with I/DD, including how medications sensitize people with developmental disabilities to pain differently than other populations and pain may be managed in various ways. Resources for Integrated Care has developed resources that explore how pain is assessed and managed in people with I/DD.
13 Baldridge, K. H. & Andrasik, F. (2010). Pain Assessment in People with Intellectual or Developmental Disabilities. American Journal of Nursing, 110(12), 28-35.
1 Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., … Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults. Morbidity and Mortality Weekly Report, 67, 1001-1006. http://dx.doi.org/10.15585/mmwr.mm6736a2.
2 Patel, K. V., Guralnik, J. M., Dansie, E. J., & Turk, D. C. (2013). Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain, 154(12), 2649–2657. doi:10.1016/j.pain.2013.07.029.
3 Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., … Helmick, C. (2018).
4 Ayres, E., Warmington, M., Reid, M. (2012). Managing chronic pain in older adults: 6 steps to overcoming medication barriers. The Journal of Family Practice, 61(9), S16-S21. Retrieved from https://www.mdedge.com/familymedicine/article/116938/geriatrics/managing-chronic-pain-older-adults-6-steps-overcoming.
6 International Association for the Study of Pain. (2019). Pain in Individuals with an Intellectual Disability: Scope of the Problem and Assessment Challenges. Retrieved from: http://s3.amazonaws.com/rdcms-iasp/files/production/public/2019GlobalYear/Fact_Sheets/9_Pain_in_Individuals_with_an_Intellectual_Disability_Scope_of_the%20Prob.pdf.