Nearly two-thirds of older, disabled women report significant pain in their back, knees, hips, and feet, and have considerable difficulty controlling it, according to new findings from the National Institute on Aging's (NIA) Women's Health & Aging Study. The analysis, one of the first to look at doses of medication in relation to pain, found that almost half of women with severe pain took very small amounts of medication or no medication at all. In a smaller percentage of cases, they took too much. This mismatch of pain to effective medication, the researchers said, suggests a need for more effective strategies for managing pain in older people.
This portrait of pain among older women comes from a report by Marco Pahor, M.D., University of Tennessee, Memphis, Jack M. Guralnik, M.D., Ph.D., at the NIA, and colleagues, whose findings appear in the June 1999 issue of the American Journal of Public Health. The report is based on data from the Women's Health & Aging Study, a collaborative project of NIA and Linda P. Fried, M.D., M.P.H., and colleagues at Johns Hopkins University, Baltimore, MD.
"Joint pain in the lower extremities is very common among older women and has a powerful impact on their function and overall quality of life," said Guralnik, who is chief of the NIA's Epidemiology and Demography Office. "The high prevalence of pain found in this study, coupled with the finding that many women with severe pain are getting little relief, is certainly cause for concern."
Researchers examined data on 1,002 participants in the Baltimore area age 65 and older in the Women's Health & Aging Study, a longitudinal study designed to examine the causes and course of disability among older women. At the start of the study, participants had trouble in at least 2 out of 4 functional 'domains,' including mobility and basic self-care tasks. For this analysis, researchers looked at the severity of pain reported by the women, who had been asked to rate the pain in their lower back, hips, knees or feet on a scale of 0 to 10 while walking, using stairs, or standing upright. The type and dose of analgesic medications taken by the participants, such as aspirin, acetaminophen, or nonsteroidal anti-inflammatories, were also recorded.
About two-thirds of the women reported notable pain; half, about 49 percent, said they were in severe pain, and an additional 22 percent rated their pain as moderate. Ten percent said their discomfort was mild, and nearly 20 percent said they had no pain at all. For women with severe pain, the most frequent sites were the knees or hips, followed by lower back pain for about 21 percent and foot pain for about 17 percent.
Pahor and colleagues found that 79 percent of the study participants used some type of analgesic medication. Acetaminophen was used most frequently (by 41 percent of the women), followed by aspirin (34 percent) and ibuprofen (11 percent). A combination of two or more analgesics was used by 29 percent of the participants.
But while 87 percent of women with severe pain took at least some medication, researchers were surprised by the large proportion of women with severe pain who used very little medication. Some 41 percent took less than 20 percent of the maximum recommended analgesic dose or used no pain reliever at all. In contrast, some 9 percent of the group overall used more medication than is recommended, a finding that confirms earlier reports.
The researchers suggest that the cost of the drugs or lack of contact with physicians may be important factors in the use of low doses, and they cited data in their study showing that the people taking little or no medication had lower income and had not seen a doctor in the past six months. However, they pointed out, other factors, not monitored in the study, might account for the low dose observation, including adverse reactions to some of the drugs or the ineffectiveness of previous or current treatment. "We need to find out more about why older women are taking such minimum, and possibly ineffective, doses of medication," said Pahor.
The NIA, part of the National Institutes of Health, conducts and supports research on the biological, medical, social, and behavioral aspects of aging. A key part of the Institute's research program is aimed at maintaining independence and reducing frailty among the growing population of older people.
Journal
American Journal of Public Health