Softbound ▪ 201 pages ▪ ISBN 978-0-931092-70-1 ▪ Published April 2008
Behind the Book: Thomas and Heather Hadjistavropoulos
Pain Management for Older Adults: A Self-Help Guide
IASP members Thomas and Heather Hadjistavropoulos and their contributors have developed a handbook with advice for older adults with chronic pain problems. IASP Press has published this new book in soft cover as its first patient-oriented book. We asked Thomas and Heather to describe why the book is such an important resource.
Q: Is pain a natural part of growing old?
Thomas: Although pain accompanies many illnesses that affect older people (such as osteoarthritis or cancer), it is not the result of old age, but a consequence of disease, illness, or injury that needs to be treated or managed. If we think of pain as a natural part of being old, we may be less inclined to treat it effectively. Persistent pain needs to be managed regardless of a person's age.
Q: Do you see self-help strategies becoming more important as the population ages?
Thomas: With the graying of the baby boom and advances in health care, we are seeing a dramatic increase in the proportion of older adults in society. There are many questions about the extent to which the health care system will be able to meet the needs of the changing demographic. While the effective management of pain will require health care system resources in most cases, effective self-management has the potential of reducing health care visits and the associated costs.
Q: What are some common misconceptions that older persons have about their chronic pain?
Thomas: There are many of these. Sometimes people think of pain in old age as being "natural" and something that needs to be endured. Although pain problems are frequent in old age, they are never "natural." They are symptoms of disease or underlying pathology and should be treated. Other examples include views that analgesics and pain killers are the only line of defense against chronic pain, whereas we know that a variety of approaches, including psychological pain management strategies, can also play a key role in managing pain.
Q: What is unique about Pain Management for Older Adults: A Self-Help Guide?
Thomas: While there are several self-help books designed to help people manage their pain and cope with associated stress, not much attention has been paid, within the self-help literature, to the management of pain among older adults. Older adults are different in many respects. Age-related changes in our bodies result in the need for different medication dosages. Recommendations for physical activity programs also are different among older adults. Moreover, the types of stressors that older adults face — such as empty nest syndrome and widowhood — tend to be different from those of younger persons. As such, the type of pain management and related stress management information needs to be tailored to the context of the older adult. This is what we hope we have accomplished with our book. The book brings together many clinical experts, representing the disciplines of medicine, clinical psychology, nursing, exercise therapy, kinesiology, dietetics, and pharmacy with vast combined experience in the medical, psychosocial, and physical management of chronic pain.
Q: What kind of clinical experience does each of you have with older patients?
Thomas: My professional training is in clinical psychology. I began clinical work with older adults approximately 18 years ago. After noticing the high frequency of pain problems among older persons, I became very interested in pain assessment and management among seniors. My clinical work with older persons has focused on assessment and psychosocial pain management (e.g., helping people deal with the psychological consequences of chronic pain) in conjunction with regular medical care.
Heather: My clinical practice is quite diverse. Some of my practice is focused on the psychological assessment of people who suffer from chronic pain. I also provide psychological treatment to individuals who have anxiety disorders, mood disorders, or adjustment disorder in response to a medical condition. I use a cognitive-behavioral approach in my work with clients. My work with older adults typically focuses on facilitating adjustment to chronic medical conditions. This work often involves assisting with development of strategies for dealing with pain, depression, or anxiety. The work can also involve helping clients make general changes in their health habits, such as increasing exercise, eating better, or quitting smoking. At the University of Regina, I started a Psychology Training Clinic a number of years ago. At this time, I am exclusively supervising students who are interested in working with older adults who are anxious about their health. This anxiety about health is often triggered by experiences with pain from a variety of medical conditions.
Q: What are some of the ways you keep readers motivated to progress through the book and to start practicing the self-help techniques?
Thomas: We present the information in a language that lay people can relate to and understand. As much as possible, we avoid scientific jargon. Where appropriate, and always using lay language, the book makes reference to scientific evidence that supports the effectiveness of approaches discussed in the book. We include vignettes to illustrate some of the problems and potential solutions that we discuss in the book, and we encourage readers to move slowly as they practice the coping skills discussed in the book. We also provide recording forms to help people monitor their practice, progress, and successes over time.
Q: Do you have a particular story about a patient who used some of the techniques you present in the book to make dramatic improvements in his or her quality of life?
Heather: One client who really stands out for me is an older man who suffered from chronic low back pain resulting from work injuries and surgeries he underwent in his 40s. When I began to work with him, he was extremely angry because he was in pain and he was at a point in his life where he was "supposed to enjoy life." He was still focused on wanting someone to fix him, and frustrated that no one was willing to operate on him. We used many of the strategies that are discussed in the book. The key to working with him was to ask him to temporarily let go of trying to get someone to operate on him and to start by having him focus on what was in his control and what he could do to improve his pain and life. We worked on changing negative thoughts, incorporating relaxation strategies, scheduling pleasant events, improving his communication with his family, and encouraging a healthy lifestyle. It was the combination of all of the strategies that helped him; no one strategy would have been effective on its own. One thing that was very rewarding about working with this client was that when we started to work together, he was very negative about seeing a psychologist and only came to see me because his wife insisted. As we worked together, however, he really opened up, and now he recommends psychologists to everyone! He no longer even thinks about surgery. He has excellent quality of life, spending time every day exercising, enjoying hobbies, and being with his family.
Q: Why should physicians recommend this book to their older patients?
Thomas: There are very few self-help pain management resources that are specifically tailored for older adults. Most importantly, the book helps foster a sense of control over one's pain, and we know that people who have an enhanced sense of control over their pain have better outcomes. In addition to describing a variety of self-management coping strategies, the book provides useful educational information about topics such as pain management medication, sleep hygiene, and nutrition. Physicians often provide such information to their patients, but time constraints limit the amount of information they can provide. Having such information available in written form can help patients understand the information, while saving time in the medical office.
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