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      “I Try and Smile, I Try and Be Cheery, I Try Not to Be Pushy. I Try to Say ‘I'm Here for Help’ but I Leave Feeling… Worried”: A Qualitative Study of Perceptions of Interactions with Health Professionals by Community-Based Older Adults with Chronic Pain

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          Abstract

          Background

          Over 50% of community-dwelling older adults experience chronic pain, which threatens their quality of life. Of importance to their pain management is older people's interaction with health professionals that, if unsatisfactory, may impair the outcome.

          Aims

          To add to the limited research specific to older people living with chronic pain in the community, we explored how they perceive their experiences of interacting with health professionals, seeking factors that might optimise these interactions.

          Methods

          Purposive sampling was used to recruit men and women >65 years with self-reported musculoskeletal chronic pain. Qualitative individual interviews and one group interview were undertaken with 23 participants. Data were transcribed verbatim and underwent Framework Analysis.

          Results

          Three themes were identified. Seeking help illustrates issues around why older people in the community may or may not seek help for chronic pain, and highlights the potential involvement of social comparison. Importance of diagnosis illustrates the desire for professional validation of their condition and an aversion to vague explanations based on the person's age. Being listened to and being heard illustrates the importance of empathic communication and understanding expectations, with due respect for the person's age.

          Conclusions

          In common with people of all ages, an effective partnership between an older person in pain and health professionals is essential if pain is to be reported, appropriately assessed and managed, because of the subjective nature of pain and its treatment responses. For older people with pain, perception about their age, by both parties in the partnership, is an additional factor that can unnecessarily interfere with the effectiveness of this partnership. Health professionals should engage with older adults to clarify their expectations about pain and its management, which may be influenced by perceptions about age; and to encourage expression of their concerns, which may also be affected by perceptions about age.

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          Most cited references 16

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          The epidemiology of chronic pain in the community.

          Chronic pain is recognised as an important problem in the community but our understanding of the epidemiology of chronic pain remains limited. We undertook a study designed to quantify and describe the prevalence and distribution of chronic pain in the community. A random sample of 5036 patients, aged 25 and over, was drawn from 29 general practices in the Grampian region of the UK and surveyed by a postal self-completion questionnaire. The questionnaire included case-screening questions, a question on the cause of the pain, the chronic pain grade questionnaire, the level of expressed needs questionnaire, and sociodemographic questions. 3605 questionnaires were returned completed. 1817 (50.4%) of patients self reported chronic pain, equivalent to 46.5% of the general population. 576 reported back pain and 570 reported arthritis; these were the most common complaints and accounted for a third of all complaints. Backward stepwise logistic-regression modelling identified age, sex, housing tenure, and employment status as significant predictors of the presence of chronic pain in the community. 703 (48.7%) individuals with chronic pain had the least severe grade of pain, and 228 (15.8%) the most severe grade. Of those who reported chronic pain, 312 (17.2%) reported no expressed need, and 509 (28.0%) reported the highest expressed need. Chronic pain is a major problem in the community and certain groups within the population are more likely to have chronic pain. A detailed understanding of the epidemiology of chronic pain is essential for efficient management of chronic pain in primary care.
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            Perceptions of joint pain and feeling well in older people who reported being healthy: a qualitative study.

            Older people often view osteoarthritis as a part of normal ageing and see themselves as healthy despite painful joints. Professionals have mixed views about this. One concern is that seeing osteoarthritis as a result of 'wear and tear' leads to restricting exercise in order to avoid further wear. To explore lay perceptions of wellness and joint pain, and their implications for consulting healthcare professionals and taking exercise. Qualitative, longitudinal study. General practice in the North Midlands. Semi-structured interviews with 27 older people who reported a joint problem but rated themselves as healthy. Diary sheets were sent for 11 consecutive months to record changes in health and circumstances. Thematic data analysis was facilitated by NVivo 8. A key element of wellness was being able to continue with everyday roles and activities. 'Wear and tear' was used to categorise arthritis that is a normal part of old age. New joint symptoms that came on suddenly and severely were not necessarily attributed to 'wear and tear' arthritis, and were likely to lead to a professional consultation. Physical activity was not restricted to prevent further wear of affected joint(s). Keeping joints mobile was important in order to maintain independence. Professionals should explore patients' ideas and concerns about their joint problem, in order to individually tailor explanations and advice. Patients are likely to be receptive to recommendations that promote independence, but advice needs to be set into patients' existing ways of living and coping with joint pain.
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              Pain and aging: the emergence of a new subfield of pain research.

              The pain and aging subfield has grown dramatically, including a 6-fold increase in publications over the last 2 decades. This subfield is based on the assumption that pain in older and younger adults differs in clinically and theoretically significant ways. If this were not the case, data from younger groups could be generalized to older persons, and the subfield would not be needed. This article considers the evidence for this assumption. Possible interpretations of the discrepant findings of age-related increases, decreases and stability in pain, including methodological limitations, challenges of gerontological research, and the possibility of nonuniform age-related variation, are discussed. Evidence is presented for several unique characteristics of geriatric pain: difficulty using Visual Analog Scales, increased vulnerability to neuropathic pain, decreased vulnerability to acute pain related to visceral pathology, prolonged recovery from tissue and nerve injury, including prolonged hyperalgesia, and differences in the relationships among psychosocial factors important in adjustment to chronic pain. However, without a theoretical framework, it is difficult to integrate these results in a heuristic manner. Further research is needed to elucidate the characteristics of geriatric pain, to examine the mechanisms for age-related patterns, and to develop and test the efficacy of age-tailored interventions. This article reviews the emerging subfield of pain and aging, discusses the interpretation of age-related patterns in pain, and presents several avenues for future research and subfield development. This could contribute to the continued growth of this subfield.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                4 September 2014
                : 9
                : 9
                Affiliations
                [1 ]School of Health, Community and Education Studies, Northumbria University, Newcastle, United Kingdom
                [2 ]Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom
                [3 ]School of Health and Social Care, University of Greenwich, London, United Kingdom
                [4 ]Medical Research Institute, University of Dundee, Dundee, United Kingdom
                [5 ]School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
                University of Missouri Kansas CIty School of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Analyzed the data: DM DJ PS BS GA PM. Contributed reagents/materials/analysis tools: AC DG DM DJ BS PS PM GA. Wrote the paper: AC DM DJ PS GA PM DG BS. Used framework analysis for this research: AC DG. Conducted most of the data collection: AC DG. Wrote the first draft of this article: AC. Contributed to the data analysis and results: DM DJ BS PM PS. Conducted the interviews: AC DG.

                Article
                PONE-D-14-10153
                10.1371/journal.pone.0105450
                4154857
                25187952

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 7
                Funding
                This study was funded by the Medical Research Council as part of the Lifelong Health and Wellbeing programme. The funders had no role in the design, execution, analysis and interpretation of the data, or writing of the study.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Geriatrics
                Health Care
                Neurology
                Neuromuscular Diseases
                Fibromyalgia
                Pain Management
                Pain
                Rheumatic Pain
                Rheumatology
                Arthritis

                Uncategorized

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