As a clinical nurse specialist in gerontology, Susan Ruzicka, Ph.D., R.N., has worked with older clients with dementia who suffered from chronic pain.
"Much of their behavior, which may be a result of chronic pain, was ignored. The source of the behavior was not being treated. Chronic pain in the elderly is very prevalent," said Dr. Ruzicka, an assistant professor in the Department of Family Nursing Care.
It was this experience of working with older patients that inspired Dr. Ruzicka to study chronic pain in the elderly. "Often they suffer needlessly. More accurate assessment of chronic pain enables caregivers to better manage the individual's pain, that may lead to more comfort for the older adult," she explained.
The first of her three research projects involved determining what elders believe about chronic pain.
"Elders' attitudes about pain should guide how they are treated by caregivers," she said. "They all have different thresholds of pain and handle pain differently. This research indicated that health professionals should not have predisposed ideas of what pain is for the elderly. We must learn how each individual is affected by it."
After learning what elders believed, Dr. Ruzicka was prepared to begin her second research study to assess pain. The study involved 150 cognitively intact individuals age 65 and older who suffered from chronic pain. (She later hopes to perform research with cognitively impaired elders using her current research findings as a basis for those studies.)
"We must look at pain multi-dimensionally. We assessed pain using seven dimensions: physiological, behavioral, sensory, affective, cognitive, sociocultural and spiritual," she said. "We must look at all the factors that influence the entire person. Pain is not experienced in only one realm."
Historically, pain has been treated uni-dimensionally, Dr. Ruzicka said. "It often was treated pharmacologically - with pain medicine and that was it. Acute pain reveals the etiology. The pain has a purpose; it is telling us something is wrong.
"However, chronic pain is different. It often seems to have no purpose and has great potential to interrupt daily routines and social life. We need to look at different ways to treat it so that we can improve the quality of life of these elders."
The physiological dimension was studied by asking each participant to rank pain on a scale from 1 to 10 and then describe the pain. The behavioral dimension studied how pain affects the person's mobility and daily activities. The affective dimension looked at how chronic pain has affected people emotionally.
The cognitive dimension deals with elders' beliefs about chronic pain. "Some individuals believe they have some control over the pain where others do not. Some people believe pain is out of their control," she said.
For the sociocultural dimension, the study examined how pain changed the elders' relations with family and friends.
The final dimension involves the person's spiritual well-being. "We asked about elders' relationship with a higher being. The questions deal with the individual's feeling of support from a higher being," she explained.
Dr. Ruzicka said her research affirmed the importance of multi-dimensional assessment of chronic pain. The results from the study also supported the significance and importance of spirituality in relation to pain. Little research has been done regarding spirituality as a separate, important dimension to consider when treating a patient. This study indicates the necessity to include the spiritual role in managing chronic pain, she said.
The third part of this research is under way. It involves applying what was learned in the first two studies and offering methods to manage the pain. These methods include breathing techniques and certain exercises.
Study participants attend three workshops and learn about pain intervention. Each person chooses which types of intervention he wants to try and then maintains a daily log. "As a nurse, I sit down with them and review what they are doing and offer suggestions on changing their routine or affirmations on the activities they are doing," she said.
Dr. Ruzicka said participants are told to ask their physicians about starting a new exercise routine. "We want their physicians to know what they are doing in the study. Although specific pharmacological intervention is not a part of the study, if physicians have prescribed something for pain, then participants are encouraged to take their medications as needed and indicated. These interventions are not a replacement to pain medicine - they are to be used with pain medication to more effectively manage chronic pain.
"Two participants have said they have been able to reduce the amount of pain medicine they are taking because of participation in the study," she said. "I review all the interventions on a weekly basis, including the pharmacological ones, and offer suggestions on how to better tailor the pain management plan for each person."
Simple strategies, such as breathing activities and physical exercise, can affect the emotional and functional well-being of individuals, she said. "That is what makes all of this worth it. The ultimate goal is to teach elders how to better manage their chronic pain so the pain does not manage them."