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Older patients ‘more likely to under-report pain’ after major operations

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Measuring functional impairment might be a better tool for postoperative pain assessment in older patients than asking them about their pain levels, suggest German researchers.

The study authors noted that age played a part in the level of pain reported after major surgery, with previous studies suggesting older people were more likely to better tolerate it.

“Elderly patients might tend to under-report their pain levels”

Study authors

But pain-related impact on physical function does not decline, suggesting older patients are in fact experiencing pain but not admitting to it, according to the researchers from Jena University Hospital.

At least half of surgical patients experienced moderate to severe pain after common operations, they said, based on previous research.

However, they noted that individual perceptions of pain intensity, impairments caused by pain, and effectiveness of pain relief differ depending on the type of surgery, medication, gender, and age.

In the new study, the researchers used data from the PAIN OUT registry – an international acute pain registry and research project that collects patient-reported outcome data on day one after surgery.

They examined both pain intensity and functional impairment in 2,390 patients who underwent a total knee replacement in 54 hospitals around the world from February 2010 to November 2016.

“Asking about functional impairment might be a better tool for pain assessment”

Study authors

The results showed a clear trend of reported pain scores decreasing with increasing age. However, functional impairment scores did not decrease with increasing age, highlighted the researchers.

They said: “Our study confirms that the older the patients, the lower their reported maximum pain levels. However, elderly patients do not report less functional impairment caused by pain.

“These findings suggest that elderly patients might tend to under-report their pain levels, and that asking about functional impairment might be a better tool for pain assessment,” they said.

They added: “Is it more likely that older patients do not report pain for ‘social’ reasons – for example, they think pain is normal or they have to bear it without complaint.”

The study results were presented as a poster titled “tough cookies” (see attached PDF, below) at this year’s Euroanaesthesia congress in Geneva. The work has yet to be submitted to a journal for publication.

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