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Pain and Aging: The Emergence of a New Subfield of Pain Research

  • Lucia Gagliese
    Correspondence
    Address reprint requests to Dr Lucia Gagliese, University Health Network, EN9-236A, 200 Elizabeth Street, Toronto Ontario, Canada M5G 2C4.
    Affiliations
    School of Kinesiology and Health Science, York University, Toronto, Canada; Department of Anesthesia and Pain Management, Behavioural Sciences and Health Research Division, Psychosocial Oncology and Palliative Care Research Division, University Health Network, Toronto, Canada; and Departments of Anesthesia and Psychiatry, University of Toronto, Toronto, Canada
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      Abstract

      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.

      Perspective

      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.

      Key words

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      References

      1. AGS Panel on Chronic Pain in Older Persons: The management of chronic pain in older persons.
        J Am Geriatr Soc. 1998; 46: 635-651
        • Alkema G.E.
        • Alley D.E.
        Gerontology's future: An integrative model for disciplinary advancement.
        Gerontologist. 2006; 46: 574-582
        • Andersson H.I.
        • Ejilertsson G.
        • Leden I.
        • Rosenberg C.
        Chronic pain in a geographically defined population: Studies of differences in age, gender, social class and pain localization.
        Clin J Pain. 1993; 9: 174-182
        • Ashcroft G.S.
        • Mills S.J.
        • Ashworth J.J.
        Ageing and wound healing.
        Biogerontology. 2002; 3: 337-345
        • Benesh L.R.
        • Szigeti E.
        • Ferraro F.R.
        • Gullicks J.N.
        Tools for assessing chronic pain in rural elderly women.
        Home Healthcare Nurse. 1997; 15: 207-211
        • Bennett G.J.
        Hypotheses on the pathogenesis of herpes zoster-associated pain.
        Ann Neurol. 1994; 35: S38-S41
        • Bernabei R.
        • Gambassi G.
        • Lapane K.
        • Landi F.
        • Gatsonis C.
        • Dunlop R.
        • Lipsitz L.
        • Steel K.
        • Mor V.
        Management of pain in elderly patients with cancer.
        JAMA. 1998; 279: 1877-1882
        • Blyth F.M.
        • March L.M.
        • Brnabic A.J.M.
        • Jorm L.R.
        • Williamson M.
        • Cousins M.J.
        Chronic pain in Australia: A prevalence study.
        Pain. 2001; 89: 127-134
        • Cassel C.K.
        Geriatric medicine: An evidence-based approach.
        Springer, New York2003
        • Cavanaugh J.C.
        • Whitbourne S.K.
        Research methods.
        in: Cavanaugh J.C. Whitbourne S.K. Gerontology: An interdisciplinary perspective. Oxford University Press, New York1999: 33-64
      2. Centers for Disease Control and Prevention and The Merck Company Foundation: The State of Aging and Health in America 2007.
        The Merck Company Foundation, Whitehouse Station, NJ2007
        • Chakour M.C.
        • Gibson S.J.
        • Bradbeer M.
        • Helme R.D.
        The effect of age on A delta- and C-fibre thermal pain perception.
        Pain. 1996; 64: 143-152
        • Charlton J.E.
        Core curriculum for professional education in pain.
        IASP Press, Seattle2005
        • Chibnall J.T.
        • Tait R.C.
        Pain assessment in cognitively impaired and unimpaired older adults: A comparison of four scales.
        Pain. 2001; 92: 173-186
        • Chodosh J.
        • Solomon D.H.
        • Roth C.P.
        • Chang J.T.
        • MacLean C.H.
        • Ferrell B.A.
        • Shekelle P.G.
        • Wenger N.S.
        The quality of medical care provided to vulnerable older patients with chronic pain.
        J Am Geriatr Soc. 2004; 52: 756-761
        • Choi S.J.
        • Harii K.
        • Lee M.J.
        • Furuya F.
        • Ueda K.
        Electrophysiological, morphological, and morphometric effects of aging on nerve regeneration in rats.
        Scand J Plast Reconstr Hand Surg. 1995; 29: 133-140
        • Choo P.W.
        • Galil K.
        • Donahue J.G.
        • Walker A.M.
        • Spiegelman D.
        • Platt R.
        Risk factors for postherpetic neuralgia.
        Arch Intern Med. 1997; 157: 1217-1224
        • Closs S.J.
        • Barr B.
        • Briggs M.
        • Cash K.
        • Seers K.
        A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment.
        J Pain Sympt Manage. 2004; 27: 196-205
        • Cohen M.Z.
        • Musgrave C.F.
        • Munsell M.F.
        • Mendoza T.R.
        • Gips M.
        The cancer pain experience of Israeli and American patients 65 years and older.
        J Pain Sympt Manage. 2005; 30: 254-263
        • Coleman P.
        • Finch C.
        • Joseph J.
        The need for multiple time points in aging studies.
        Neurobiol Aging. 1990; 11: 1-2
        • Cook A.J.
        • Brawer P.A.
        • Vowles K.E.
        The fear-avoidance model of chronic pain: Validation and age analysis using structural equation modeling.
        Pain. 2006; 121: 195-206
        • Cooney T.M.
        • Schaie K.W.
        • Willis S.L.
        The relationship between prior functioning on cognitive and personality dimensions and subject attrition in longitudinal research.
        J Gerontol. 1988; 43: P12-P17
        • Cowan D.T.
        • Fitzpatrick J.M.
        • Roberts J.D.
        • While A.E.
        • Baldwin J.
        The assessment and management of pain among older people in care homes: Current status and future directions.
        Int J Nursing Studies. 2003; 40: 291-298
        • Craig K.D.
        Emotions and psychobiology.
        in: Wall P.D. Melzack R. Textbook of Pain. Churchill Livingstone, Edinburgh1999: 331-344
        • Crisp T.
        • Giles J.R.
        • Cruce W.L.
        • McBurney D.L.
        • Stuesse S.L.
        The effects of aging on thermal hyperalgesia and tactile-evoked allodynia using two models of peripheral mononeuropathy in the rat.
        Neuroscience Lett. 2003; 339: 103-106
        • Dannefer D.
        • Uhlenberg P.
        • Foner A.
        • Abeles R.P.
        On the shoulders of a giant: The legacy of Matilda White Riley for gerontology.
        J Gerontol Series B-Psychol Sci Soc Sci. 2005; 60: S296-S304
        • de Zwart B.C.H.
        • Broersen J.P.J.
        • Frings-Dresen M.H.W.
        • van Dijk F.J.H.
        Musculoskeletal complaints in the Netherlands in relation to age, gender and physically demanding work.
        Int Arch Occup Environ Health. 1997; 70: 352-360
        • Devor M.
        Chronic pain in the aged: Possible relation between neurogenesis, involution and pathophysiology in adult sensory ganglia.
        J Basic Clin Physiol Pharmacol. 1991; 2: 1-15
        • Donald I.P.
        • Foy C.
        A longitudinal study of joint pain in older people.
        Rheumatology (Oxford). 2004; 43: 1256-1260
        • Doubell T.P.
        • Mannion R.J.
        • Woolf C.J.
        The dorsal horn: state-dependent sensory processing, plasticity and the generation of pain.
        in: Wall P.D. Melzack R. Textbook of pain. Churchill Livingstone, Edinburgh1999: 165-181
        • Dworkin R.H.
        Which individuals with acute pain are most likely to develop a chronic pain syndrome?.
        Pain Forum. 1997; 6: 127-136
        • Dworkin R.H.
        • Hartstein G.
        • Rosner H.L.
        • Walther R.R.
        • Sweeney E.W.
        • Brand L.
        A high-risk method for studying psychosocial antecedents of chronic pain: The prospective investigation of herpes zoster.
        J Abnorm Psychol. 1992; 101: 200-205
        • Dworkin R.H.
        • Turk D.C.
        • Farrar J.T.
        • Haythornthwaite J.A.
        • Jensen M.P.
        • Katz N.P.
        • Kerns R.D.
        • Stucki G.
        • Allen R.R.
        • Bellamy N.
        • Carr D.B.
        • Chandler J.
        • Cowan P.
        • Dionne R.
        • Galer B.S.
        • Hertz S.
        • Jadad A.R.
        • Kramer L.D.
        • Manning D.C.
        • Martin S.
        • McCormick C.G.
        • McDermott M.P.
        • McGrath P.
        • Quessy S.
        • Rappaport B.A.
        • Robbins W.
        • Robinson J.P.
        • Rothman M.
        • Royal M.A.
        • Simon L.
        • Stauffer J.W.
        • Stein W.
        • Tollett J.
        • Wernicke J.
        • Witter J.
        IMMPACT: Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2005; 113: 9-19
        • Edwards R.R.
        Age differences in the correlates of physical functioning in patients with chronic pain.
        J Aging Health. 2006; 18: 56-69
        • Edwards R.R.
        • Fillingim R.B.
        Age-associated differences in responses to noxious stimuli.
        J Gerontol Series A: Biol Med Sci. 2001; 56: M180-M185
        • Edwards R.R.
        • Fillingim R.B.
        Effects of age on temporal summation of thermal pain: Clinical relevance in healthy older and younger adults.
        J Pain. 2001; 2: 307-317
        • Edwards R.R.
        • Fillingim R.B.
        • Ness T.J.
        Age-related differences in endogenous pain modulation: A comparison of diffuse noxious inhibitory controls in healthy older and younger adults.
        Pain. 2003; 101: 155-165
        • Estes C.L.
        • Binney E.A.
        The biomedicalization of aging: Dangers and dilemmas.
        Gerontologist. 1989; 29: 587-596
        • Feldt K.S.
        • Ryden M.B.
        • Miles S.
        Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture.
        J Am Geriatr Soc. 1998; 46: 1079-1085
        • Ferraro K.F.
        Imagining the disciplinary advancement of gerontology: Whither the tipping point?.
        Gerontologist. 2006; 46: 571-573
        • Ferrell B.A.
        Overview of aging and pain.
        in: Ferrell B.R. Ferrell B.A. Pain in the Elderly. IASP Press, Seattle1996: 1-10
        • Ferrell B.A.
        • Ferrell B.R.
        • Rivera L.
        Pain in cognitively impaired nursing home residents.
        J Pain Sympt Manage. 1995; 10: 591-598
        • Ferrell B.R.
        • Juarez G.
        Cancer pain education for patients and the public.
        J Pain Sympt Manage. 2002; 23: 329-336
        • Fox P.L.
        • Raina P.
        • Jadad A.R.
        Prevalence and treatment of pain in older adults in nursing homes and other long-term care institutions: A systematic review.
        Can Med Assoc J. 1999; 160: 329-333
        • Gagliese L.
        What do experimental pain models tell us about aging and clinical pain?.
        Pain Med. 2007; 8: 475-477
        • Gagliese L.
        • Farrell M.J.
        The neurobiology of ageing, nociception and pain: An integration of animal and human experimental evidence.
        in: Gibson S.J. Weiner D.K. Progress in Pain Research and Management: Pain in the Older Person. IASP Press, Seattle2005: 25-44
        • Gagliese L.
        • Gauthier L.R.
        • Macpherson A.K.
        • Jovellanos M.
        • Chan V.W.S.
        Correlates of postoperative pain and intravenous patient-controlled analgesia use in younger and older surgical patients.
        Pain Med. 2008; 9: 299-314
        • Gagliese L.
        • Gauthier L.R.
        • Rodin G.
        Cancer pain and depression: A systematic review of age-related patterns.
        Pain Res Manage. 2007; 12: 205-211
        • Gagliese L.
        • Katz J.
        Age differences in postoperative pain are scale dependent: A comparison of measures of pain intensity and quality in younger and older surgical patients.
        Pain. 2003; 103: 11-20
        • Gagliese L.
        • Katz J.
        Pain research and treatment in the gerontological context: An evidence-based response.
        Pain Res Manage. 1999; 3: 186-187
        • Gagliese L.
        • Melzack R.
        Age differences in the quality of chronic pain: A preliminary study.
        Pain Res Manage. 1997; 2: 157-162
        • Gagliese L.
        • Melzack R.
        Age-related differences in the qualities but not the intensity of chronic pain.
        Pain. 2003; 104: 597-608
        • Gagliese L.
        • Melzack R.
        Pain in the elderly.
        in: McMahon S.B. Koltzenburg M. Melzack and Wall's Textbook of Pain. Elsevier, Edinburgh2006: 1169-1179
        • Gagliese L.
        • Weizblit N.
        • Ellis W.
        • Chan V.W.S.
        The measurement of postoperative pain: A comparison of intensity scales in younger and older surgical patients.
        Pain. 2005; 117: 412-420
        • Geerlings S.W.
        • Twisk J.W.R.
        • Beekman A.T.F.
        • Deeg D.J.H.
        • van Tilburg W.
        Longitudinal relationship between pain and depression in older adults: Sex, age and physical disability.
        Soc Psychiatry Psychiatric Epidemiol. 2002; 37: 23-30
        • Geisler E.
        The measurement of scientific activity: Research directions in linking philosophy of science and metrics of science and technology outputs.
        Scientometrics. 2005; 62: 269-284
        • Gibson S.J.
        • Weiner D.K.
        Progress in Pain Research and Management: Pain in the Older Person.
        IASP Press, Seattle2005
        • Given C.W.
        • Given B.
        • Azzouz F.
        • Kozachik S.
        • Stommel M.
        Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients.
        J Pain Sympt Manage. 2001; 21: 456-466
        • Given C.W.
        • Given B.
        • Azzouz F.
        • Stommel M.
        • Kozachik S.
        Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer.
        Med Care. 2000; 38: 482-493
        • Godwin M.
        Hypothesis: The research page, Part 3: Power, sample size, and clinical significance.
        Can Fam Physician. 2001; 47: 1441-1443
        • Hadjistavropoulos T.
        Assessing pain in older persons with severe limitations in ability to communicate.
        in: Gibson S.J. Weiner D.K. Progress in Pain Research and Management: Pain in the Older Person. IASP Press, Seattle2005: 135-151
        • Hadjistavropoulos T.
        • Craig K.D.
        • Martin N.
        • Hadjistavropoulos H.
        • McMurtry B.
        Toward a research outcome measure of pain in frail elderly in chronic care.
        Pain Clin. 1997; 10: 71-79
        • Hadjistavropoulos T.
        • Herr K.
        • Turk D.C.
        • Fine P.G.
        • Dworkin R.H.
        • Helme R.
        • Jackson K.
        • Parmelee P.A.
        • Rudy T.E.
        • Beattie B.L.
        • Chibnall J.T.
        • Craig K.D.
        • Ferrell B.
        • Ferrell B.
        • Fillingim R.B.
        • Gagliese L.
        • Gallagher R.
        • Gibson S.J.
        • Harrison E.L.
        • Katz B.
        • Keefe F.J.
        • Lieber S.J.
        • Lussier D.
        • Schmader K.E.
        • Tait R.C.
        • Weiner D.K.
        • Williams J.
        An interdisciplinary expert consensus statement on assessment of pain in older persons.
        Clin J Pain. 2007; 23: S1-S43
        • Harel O.
        • Hofer S.M.
        • Hoffman L.
        • Pedersen N.L.
        Population inference with mortality and attrition in longitudinal studies on aging: A two-stage multiple imputation method.
        Exp Aging Res. 2007; 33: 187-203
        • Haug M.R.
        Elderly patients and their doctors.
        Springer, New York1981
        • Hayflick L.
        The future of ageing.
        Nature. 2000; 408: 267-269
        • Helme R.D.
        • Katz B.
        • Gibson S.
        • Corran T.
        Can psychometric tools be used to analyse pain in a geriatric population?.
        Clin Exp Neurol. 1989; 26: 113-117
        • Herr K.
        • Bjoro K.
        • Decker S.
        Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review.
        J Pain Sympt Manage. 2006; 31: 170-192
        • Herr K.A.
        • Mobily P.R.
        Comparison of selected pain assessment tools for use with the elderly.
        Appl Nursing Res. 1993; 6: 39-46
        • Herr K.A.
        • Spratt K.
        • Mobily P.R.
        • Richardson G.
        Pain intensity assessment in older adults: Use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults.
        Clin J Pain. 2004; 20: 207-219
        • Hunt T.E.
        Pain and the aged patient.
        in: Smith W. Merskey H. Gross S. Pain: Meaning and Management. SP Medical & Scientific, New York1980: 143-157
        • Hurley A.C.
        • Volicer B.J.
        • Hanrahan P.A.
        • Houde S.
        • Volicer L.
        Assessment of discomfort in advanced Alzheimer patients.
        Res Nursing Health. 1992; 15: 369-377
        • Idler E.L.
        Age differences in self - assessments of health: Age changes, cohort differences, or survivorship?.
        J Gerontol. 1993; 48: S289-S300
        • Inouye S.K.
        • Studenski S.
        • Tinetti M.E.
        • Kuchel G.A.
        Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept.
        J Am Geriatr Soc. 2007; 55: 780-791
        • Janig W.
        • Levine J.D.
        Autonomic-endocrine-immune interactions in acute and chronic pain.
        in: McMahon S.B. Koltzenburg M. Melzack and Wall's Textbook of Pain. Elsevier, Edinburgh2006: 205-218
        • Jensen M.P.
        • Karoly P.
        • Braver S.
        The measurement of clinical pain intensity: A comparison of six methods.
        Pain. 1986; 27: 117-126
        • Jones G.T.
        • Macfarlane G.J.
        Epidemiology of pain in older persons, Progress in Pain Research and Management.
        in: Gibson S.J. Weiner D.K. Progress in Pain Research and Management: Pain in the Older Person. IASP Press, Seattle2005: 3-22
        • Jones G.T.
        • Silman A.J.
        • Power C.
        • Macfarlane G.J.
        Are common symptoms in childhood associated with chronic widespread body pain in adulthood? Results from the 1958 British birth cohort study.
        Arthritis Rheum. 2007; 56: 1669-1675
        • Jones L.V.
        • Lewandowski C.A.
        • Harrington D.
        • Castellanos-Brown K.
        • Larkin H.
        • Miller D.
        • Joe S.
        • Combes-Orme T.
        • Kropf N.P.
        • Gonyea J.G.
        Life span.
        in: Mizrahi T. Davis L.E. The encyclopedia of social work, edition 20. Accessed through University of Toronto Libraries, June 11, 2008. National Association of Social Workers and Oxford University Press, 2008
        • Kovacs E.J.
        • Plackett T.P.
        • Witte P.L.
        Estrogen replacement, aging, and cell-mediated immunity after injury.
        J Leukocyte Biol. 2004; 76: 36-41
        • Kovacs F.
        • Abraira V.
        • Santos S.
        • Diaz E.
        • Gestoso M.
        • Muriel A.
        • del Real M.T.G.
        • Mufraggi N.
        • Noguera J.
        • Zamora J.
        Spanish Back Pain Res Network: A comparison of two short education programs for improving low back pain-related disability in the elderly: A cluster randomized controlled trial.
        Spine. 2007; 32: 1053-1059
        • Kremer E.
        • Atkinson J.H.
        • Ignelzi R.J.
        Measurement of pain: Patient preference does not confound pain measurement.
        Pain. 1981; 10: 241-249
        • Kwentus J.A.
        • Harkins S.W.
        • Lignon N.
        • Silverman J.J.
        Current concepts in geriatric pain and its treatment.
        Geriatrics. 1985; 40: 48-57
        • Lichtenberg P.A.
        • McGrogan A.J.
        Chronic pain in elderly psychiatric inpatients.
        Clin Biofeedback Health. 1987; 10: 3-7
        • Marzinski L.R.
        The tragedy of dementia: Clinically assessing pain in the confused, nonverbal elderly.
        J Gerontol Nursing. 1991; 17: 25-28
        • McConigley R.
        • Toye C.
        • Goucke R.
        • Kristjanson L.J.
        Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care.
        Aust J Ageing. 2008; 27: 45-49
        • McNeill J.A.
        • Sherwood G.D.
        • Starck P.L.
        The hidden error of mismanaged pain: A systems approach.
        J Pain Sympt Manage. 2004; 28: 47-58
        • Mehta R.H.
        • Rathore S.S.
        • Radford M.J.
        • Wang Y.
        • Krumholz H.M.
        Acute myocardial infarction in the elderly: Differences by age.
        J Am Coll Cardiol. 2001; 38: 736-741
        • Melding P.S.
        Foreword.
        in: Gibson S.J. Weiner D.K. Progress in Pain Research and Management: Pain in the Older Person. IASP Press, Seattle2005
        • Melding P.S.
        Is there such a thing as geriatric pain?.
        Pain. 1991; 46: 119-121
        • Melzack R.
        Gate control theory: On the evolution of pain concepts.
        Pain Forum. 1996; 5: 128-138
        • Melzack R.
        • Wall P.D.
        The challenge of pain.
        Penguin Books, London1988
        • Miller J.
        • Neelon V.
        • Dalton J.
        • Ng'andu N.
        • Bailey Jr., D.
        • Layman E.
        • Hosfeld A.
        The assessment of discomfort in elderly confused patients: A preliminary study.
        J Neurosci Nursing. 1996; 28: 175-182
        • Moore A.R.
        • Clinch D.
        Underlying mechanisms of impaired visceral pain perception in older people.
        J Am Geriatr Soc. 2004; 52: 132-136
        • Mor V.
        QOL measurement scales for cancer patients: Differentiating effects of age from effects of illness.
        Oncology. 1992; 6: 146-152
        • Norton B.J.
        • Strube M.J.
        Understanding statistical power.
        J Orthop Sports Phys Ther. 2001; 31: 307-315
        • Novak J.C.
        • Lovell J.A.
        • Stuesse S.L.
        • Cruce W.L.
        • McBurney D.L.
        • Crisp T.
        Aging and neuropathic pain.
        Brain Res. 1999; 833: 308-310
        • Opstelten W.
        • Zuithoff N.P.A.
        • van Essen G.A.
        • van Loon A.M.
        • van Wijck A.J.M.
        • Kalkman C.J.
        • Verheij T.J.M.
        • Moons K.G.M.
        Predicting postherpetic neuralgia in elderly primary care patients with herpes zoster: Prospective prognostic study.
        Pain. 2007; 132: S52-S59
        • Pahor M.
        • Guralnik J.M.
        • Wan J.Y.
        • Ferrucci L.
        • Penninx B.W.
        • Lyles A.
        • Ling S.
        • Fried L.P.
        Lower body osteoarticular pain and dose of analgesic medications in older disabled women: The Women's Health and Aging Study.
        Am J Public Health. 1999; 89: 930-934
        • Parmelee P.
        Measuring mood and psychosocial function associated with pain in late life.
        in: Gibson S.J. Weiner D.K. Progress in Pain Research and Management: Pain in the Older Person. IASP Press, Seattle2005: 175-202
        • Peters M.L.
        • Patijn J.
        • Lame I.
        Pain assessment in younger and older pain patients: Psychometric properties and patient preference of five commonly used measures of pain intensity.
        Pain Med. 2007; 8: 601-610
        • Preski S.
        • Burnside I.
        Clinical research with community-based older women.
        J Gerontol Nurs. 1992; 18: 13-18
        • Reis H.T.
        Steps toward the ripening of relationship science.
        Personal Relationships. 2007; 14: 1-23
        • Reynolds K.S.
        • Hanson L.C.
        • DeVellis R.F.
        • Henderson M.
        • Steinhauser K.E.
        Disparities in pain management between cognitively intact and cognitively impaired nursing home residents.
        J Pain Sympt Manage. 2008; 35: 388-396
        • Ross M.M.
        • Crook J.M.
        Pain in later life: Present state of knowledge.
        in: Roy R. Chronic Pain in Old Age. University of Toronto Press Inc, Toronto1995: 3-19
        • Roy R.
        • Thomas M.
        A survey of chronic pain in an elderly population.
        Can Fam Physician. 1986; 32: 513-516
        • Salthouse T.A.
        Theoretical issues in the psychology of aging.
        in: Birren J.E. Schaie K.W. Handbook of the Psychology of Aging. Academic Press, 2006 (pp 3-13)
        • Scherder E.
        • Oosterman J.
        • Swaab D.
        • Herr K.
        • Ooms M.
        • Ribbe M.
        • Sergeant J.
        • Pickering G.
        • Benedetti F.
        Recent developments in pain in dementia.
        Br Med J. 2005; 330: 461A-464A
        • Schmader K.E.
        Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy.
        Clin J Pain. 2002; 18: 350-354
        • Scott F.T.
        • Leedham-Green M.E.
        • Barrett-Muir W.Y.
        • Hawrami K.
        • Gallagher W.J.
        • Johnson R.
        • Breuer J.
        A study of shingles and the development of postherpetic neuralgia in East London.
        J Med Virol. 2003; 70: S24-S30
        • Shaw R.
        Nursing research: Threats to reliability and validity in gerontology.
        J Gerontol Nurs. 1992; 18: 31-37
        • Sloman R.
        • Ahern M.
        • Wright A.
        • Brown L.
        Nurses' knowledge of pain in the elderly.
        J Pain Sympt Manage. 2001; 21: 317-322
      3. Stedman: Stedman's Medical Dictionary.
        (Available at:)ed 28. Lippincott Williams & Wilkins, Baltimore, MD2006
        • Stein W.M.
        • Miech R.P.
        Cancer pain in the elderly hospice patient.
        J Pain Sympt Manage. 1993; 8: 474-482
        • Stinson J.N.
        • Petroz G.C.
        • Tait G.
        • Feldman B.M.
        • Streiner D.
        • McGrath P.J.
        • Stevens B.J.
        e-Ouch: Usability testing of an electronic chronic pain diary for adolescents with arthritis.
        Clin J Pain. 2006; 22: 295-305
        • Stolee P.
        • Hillier L.
        • Esbaugh J.
        • Bol N.
        • McKellar L.
        • Gauthier N.
        Instruments for the assessment of pain in older persons with cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 319-326
        • Stuesse S.L.
        • Crisp T.
        • McBurney D.L.
        • Schechter J.B.
        • Lovell J.A.
        • Cruce W.L.
        Neuropathic pain in aged rats: Behavioral responses and astrocytic activation.
        Exp Brain Res. 2001; 137: 219-227
        • Thomas E.
        • Peat G.
        • Harris L.
        • Wilkie R.
        • Croft P.R.
        The prevalence of pain and pain interference in a general population of older adults: Cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP).
        Pain. 2004; 110: 361-368
        • Turk D.C.
        • Okifuji A.
        • Scharff L.
        Chronic pain and depression: Role of perceived impact and perceived control in different age cohorts.
        Pain. 1995; 61: 93-101
        • Van der Zee C.E.E.M.
        • Brakkee J.H.
        • Gispen W.H.
        Putative neurotrophic factors and functional recovery from peripheral nerve damage in the rat.
        Br J Pharmacol. 1991; 103: 1041-1046
        • Walsh D.
        • Donnelly S.
        • Rybicki L.
        The symptoms of advanced cancer: Relationship to age, gender, and performance status in 1,000 patients.
        Supportive Care Cancer. 2000; 8: 175-179
        • Ward S.E.
        • Goldberg N.
        • Miller-McCauley V.
        • Mueller C.
        • Nolan A.
        • Pawlik-Plank D.
        • Robbins A.
        • Stormoen D.
        • Weissman D.E.
        Patient-related barriers to management of cancer pain.
        Pain. 1993; 52: 319-324
        • Watt-Watson J.
        • Hunter J.
        • Pennefather P.
        • Librach L.
        • Raman-Wilms L.
        • Schreiber M.
        • Lax L.
        • Stinson J.
        • Dao T.
        • Gordon A.
        • Mock D.
        • Salter M.
        An integrated undergraduate pain curriculum, based on IASP curricula, for six health science faculties.
        Pain. 2004; 110: 140-148
        • Weiner D.
        • Peterson B.
        • Ladd K.
        • McConnell E.
        • Keefe F.
        Pain in nursing home residents: An exploration of prevalence, staff perspectives, and practical aspects of measurement.
        Clin J Pain. 1999; 15: 92-101
        • West M.
        • Bondy E.
        • Hutchinson S.
        Interviewing institutionalized elders: Threats to validity.
        Image J Nurs Sch. 1991; 23: 171-176
        • Woo J.
        • Ho S.C.
        • Lau J.
        • Leung P.C.
        Musculoskeletal complaints and associated consequences in elderly Chinese aged 70 and over.
        J Rheumatol. 1994; 21: 1927-1931
        • Yu H.-D.
        • Petrini M.A.
        A survey of Chinese nurses' current knowledge of pain in older people.
        J Clin Nursing. 2007; 16: 963-970
        • Zarit S.H.
        • Griffiths P.C.
        • Berg S.
        Pain perceptions of the oldest old: A longitudinal study.
        Gerontologist. 2004; 44: 459-468
        • Zheng Z.
        • Gibson S.J.
        • Khalil Z.
        • Helme R.D.
        • McMeeken J.M.
        Age-related differences in the time course of capsaicin-induced hyperalgesia.
        Pain. 2000; 85: 51-58
        • Zwakhalen S.M.G.
        • Hamers J.P.H.
        • Abu-Saad H.H.
        • Berger M.P.F.
        Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools.
        BMC Geriatrics. 2006; 6: 3