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End-of-Life Pain Widespread, Potentially Controllable

Roxanna Guilford-Blake, for HealthLeaders Media, November 8, 2010

In the first study to look at the prevalence of pain experienced among older people during the last two years of life, researchers at the San Francisco VA Medical Center found that 46% of study participants suffered moderate to severe pain during their final four months of life.

The researchers also found that more 26% of the participants had moderate to severe pain during the last two years of life, and that arthritis was the biggest single predictor of pain, outweighing all eventual causes of death including cancer.

For many patients approaching death, especially those with arthritis, the pain is potentially controllable.  

The study appears in the November 2, 2010 issue of the Annals of Internal Medicine.

Between 1992 and 2004, the Health and Retirement Study interviewed a nationally representative sample of community-dwelling older adults every two years about matters concerning their health. Researchers used HRS data to determine the prevalence of pain during the last years of life. The authors analyzed data from interviews conducted with 4,703 men and women age 50 and older who died while enrolled in the study.

The prevalence of pain in the last month of life was 60% among patients with arthritis versus 26% among patients without arthritis. However, the cause of death (e.g., cardiovascular disease or cancer) was not associated with important differences in the amount of pain.

"The impact of arthritis on the experience of pain among older adults has not been recognized to the extent it should be," says lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine physician at SFVAMC and an assistant professor of medicine in the division of geriatrics at the University of California, San Francisco.

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