11 Ways to Ensure Proper Pain Management

Fifty million Americans suffer from chronic pain (lasting six months or longer), and another 25 million suffer from acute pain (such as that from injuries or surgery). Most are 50 and over. "There's no question that older folks suffer a disproportionate amount of pain," says John Giglio, executive director of the American Pain Foundation. "It's underreported, undertreated, and underappreciated."

The reason is a kind of double whammy that perpetuates suffering in older patients. The first problem: patient attitudes. "Older people are notoriously reluctant to report their pain," says Matthew Loscalzo, a social worker and co-director of the Center for Cancer Pain Research at Johns Hopkins. "I've been in Saudi Arabia, China, and it's the same everywhere. It's almost an evolutional thing, a protective device. Admitting you're in pain tells the world that you're vulnerable." Older people also figure pain is just a natural, inevitable part of the aging process. "We're tough, proud, and have been taught to keep a stiff upper lip," says Loscalzo. "Many older people will actually lie about pain rather than risk hurting their physician's feelings by admitting that the initial treatment didn't work."

Generational differences may also play a part. "People under 40 are more likely to seek out pain specialists when they're not getting relief than people over 50," says Giglio.

• Don't wait until chronic pain is too severe to treat. Pain is easier to prevent than treat. Begin to understand the kinds of medications that you might take if you begin to have pain.

• Talk with your physician about your concerns for good pain care. Be assertive, and tell your doctor you will not tolerate under-treated pain.

• Demand comfort care in your advance directive. Be clear and assertive.

• Ask a family member or friend to be your advocate if you cannot speak for yourself. Keep this person informed of your pain.

• Maintain a pain record. Note location, time of day, severity, and what relieved the pain. Share with your doctor or nurse.

• If you're receiving hospice care, identify your pain level for the nurse at each visit.

• Understand your doctor's orders for your pain medication. Make sure you understand the frequency, dose and type of medication. If you have questions, ask them.

• Insist that you have enough pain medication for weekends or holidays.

• Get the names and phone numbers of any doctors covering for your physician.

• If you are hospitalized and your pain is not being treated, ask to speak to the medical director or nursing supervisor.

• For end-of-life pain, expect medication amounts to increase rapidly