Older adults' perceptions of pain medications

It is well known that chronic pain is experienced by over 50% of older adults and is challenging to treat. Published research shows that physicians are often hesitant to prescribe pain medications to elderly patients, and that older adults are often reluctant to take them, frequently utilizing risk-averse emotional heuristics in their decision process. The purpose of this research was to identify those emotional heuristics utilized by older adults in the decision on whether and how to take their pain medications. Participants in this study were an ethnically and socioeconomically diverse sample of eleven community-dwelling older adults (ages 63 – 86), all under a physician’s care for moderate to severe persistent pain. They participated in semi-structured video interviews that focused on their daily pain experience and their daily pain management strategy, which included discussions on their perceptions and use of their pain medications and use of non-medication approaches. Qualitative data analysis was used to identify heuristics employed in the decision-making process regarding use of pain medications and to create a 30-minute DVD of participants that demonstrated the major emergent themes. Results show that regardless of physician recommendations for how and when to use pain medication, participants crafted highly individual processes for their pain management and use of pain medication. Emotional heuristics were very much in use, with the chief concerns being fear of addiction, fear of side effects and total medication (pain and nonpain medication) burden consumed each day. Most participants were active consumers of written, broadcast or internet information on pain medications. A key determinant of strategy was socioeconomic status, which determined the kinds of complementary, non-pharmacological interventions that were possible and utilized. These findings are considered with respect to how older adults manage their chronic pain and include recommendations for practitioner-patient assessment regarding pain management strategy.