| One-Minute Clinician

Pain and the Geriatric Pain Population

The average geriatric patient, about 80% of them, have some chronic illnesses that they live with day to day. Because they take a lot of medicines, there are drug-drug interactions, and unintentional misuse and abuse. Studies have shown that the geriatric population… a lot of times they are getting medications from their family and friends in addition to their prescribed medications. I do urine drug screens on elderly patients just like I do with young people. Elders might take a little bit of their spouse’s hydrocodone and they themselves are on oxycodone. Many older people are in pain. In the 1970s there was a running craze, and now that they’re older, they have joint pain. Obesity, on the rise here in the United States, is a contributing factor for hip, back, and knee pain as well. Some people were involved in contact sports at an early age, and as they age, this had some impact. Some people are sedentary as they get older and movement enhances less pain. As for opioids… I think most of us had the experience of seeing a mother or grandmother make a pie. A pie doesn’t have one ingredient. If you make an apple pie, it has what? – sugar, nutmeg, cinnamon – but what happened in pain management is people think that pain management is synonymous with opioids. So they do one ingredient; everyone was getting a script for opioids. Grandmother knew best, that we had to have more than one ingredient, and that opioids, NSAIDs, physical therapy, injections, and braces are different ingredients, and if we blend them together, we do what grandmother had – a good pie. I created a system called the Bragg Factor to move people from a state of pain to function. It has five steps and starts with “behave as if.” I want people to behave as if they don’t have pain. That is the center of what Bragg Factor does. It combines motivational interviewing and the “as if” principle. The most important thing is gratitude. I have some patients keep a gratitude journal because when you’re in pain and maybe you have problems with the job and your family and your social interactions, there needs to be something that you can start your day off with that’s positive, that you’re grateful for rather than getting up saying, “I’m hurting again today.” I find that that helps to move people from focusing on pain to function when they look around at things that they can be grateful for.