Chronic Pain and Discomfort

Many elderly persons suffer from chronic illnesses such as osteoarthritis, rheumatoid arthritis, peripheral arterial disease, congestive heart failure, and diabetes. Chronic diseases are associated with pain and discomfort. Examples of diseases that are often accompanied by pain and discomfort include: diabetes with its associated peripheral neuropathies, osteoarthritis with accompanying joint stiffness and achiness, and rheumatoid arthritis (which is accompanied by muscle and joint pain). Additionally, osteoporosis, a disease prevalent in thin, small boned women, can cause nerve compression and chronic neck, back, or other pain. A definition of chronic nonmalignant pain is that it is ongoing and persists for more than three months (Pittman, 2002). Keeping the patient comfortable facilitates wellness. However, Pittman (2002) notes that chronic pain is often under-treated in the elderly. Under-treated pain and discomfort interferes with both activity and sleep. The stress from this can contribute to further ill health. Long-term care facilities are among those implicated in under-treatment. Both home care and long-term care nurses should be knowledgeable about the principles of chronic pain management in order to be able to advocate on behalf of their populations. There are guidelines and standards of care for pain management provided by JCAHO (2001). A holistic approach to chronic illness care, including comfort measures, good nutrition, and stress management is consistent with good nursing care and facilitates meeting the patient's health care needs.