By Mark Odlum
When it comes to older individuals living with chronic pain, doctor’s appointments are one of the best examples of the old adage “by failing to prepare, you are preparing to fail.”
Whether it is forgetting to bring up something at an appointment or later struggling to remember exactly what the doctor said, memory lapses or misunderstandings can have significant consequences on your health and health care.
Angie Boddie, the director of health programs for the National Caucus and Center on Black Aging, encourages patients to write things down prior to an appointment to ensure they mention everything that might be relevant.
She notes, “If I’m on a wellness visit, the [doctor is] probably not going to look at my feet. But if my feet were bothering me last week, that needs to be a part of the script, even if they’re feeling better today.”
Older individuals often are “stoic” about chronic pain, assuming it is a normal part of aging and avoiding bringing it up, says Kathy Cameron, senior director of the National Council on Aging’s Center for Healthy Aging.
“My advice: have frank conversations,” she says. “Ninety percent of the time, there are root causes for pain, and talking to your doctor can help you better understand the cause as well as appropriate treatments.”
Tips for older individuals living with chronic pain
—Write things down before the appointment and bring your notes with you, whether on paper or an electronic device. Include anything that’s bothering you, but don’t overload your doctor with irrelevant information. Make a “summary” sheet of your background, issues, and goals, as well as factors like your pain, exercise, and medications.
—Take notes during the appointment. Doctors are often in a hurry, and it can be easy to miss or misunderstand important information. That’s why it’s so vital to ask questions and take notes. If there’s anyone at the appointment with you, ask them to take notes so you can fully concentrate—in addition, some offices can provide a printed appointment summary if you ask. If English isn’t your primary language, it’s even more important to bring someone who can help you understand and communicate. There are also apps that can record and transcribe appointments, but check your local laws and give your doctor a heads up before you record them.
—Be frank and speak up. Good doctors have seen and heard it all! Never be afraid to be honest with them, even if you’re addressing something uncomfortable. Make sure to answer all their questions thoroughly, even if something doesn’t seem related.
—Investigate alternative treatments. Talk to your doctor about other possible treatment options in a range of categories, such as injections, physical therapy, occupational therapy, cognitive behavioral therapy, mindfulness, biofeedback, over-the-counter medications, devices like TENS units, acupuncture, high quality CBD products, or medical cannabis or some of its derivatives. To find more information about the legality of medical cannabis in your state, visit safeaccessnow.org, and be sure to discuss any potential treatment options with your medical provider.
Medication challenges and avoiding assumptions
Misconceptions surrounding older patients and their pain can impede effective treatment.
“There are myths around certain older adults being drug seekers and addicted to pain medication; however, they are actually suffering through pain,” says Keisha Lewis, a health program liaison with the National Caucus and Center on Black Aging. “I encourage providers to listen to the patient, attempt to understand their pain and whether there’s variance to the pain, and learn about the person. If you dismiss their pain, that can lead to other issues, like depression or mistrust in the provider.”
Another factor that can affect the patient-provider relationship is the political and legal landscape that surrounds chronic pain care. In 2016, in an attempt to reduce the impact of the opioid epidemic, the Centers for Disease Control and Prevention (CDC) released new guidelines surrounding how these medications could be prescribed. Cameron and many others quickly saw care for individuals with chronic pain deteriorate.
“We saw a significant decline in pharmacologic prescribing for pain,” Cameron shares. “[However], that was actually detrimental in some cases. Patients might have been taken off those opioids too quickly, without proper tapering. That resulted in other problems, including suicide.” (Though the CDC updated these guidelines in late 2022, the ramifications from the past guideline still exist: doctors are hesitant to prescribe any opioids to patients.)
Tips for doctors of older patients with chronic pain
—Ask questions. Discuss sleep, exercise, and mood. Ask about quality-of-life goals, like picking up a grandchild, walking to the park, or attending church. Always address the patient, even if there is a care partner or family member at the appointment. And don’t loom over them: pull up a chair!
—Make sure they understand. Explain things in a clear, concise manner. You may need to repeat yourself, or ask the patient to relay information back to you. Especially when prescribing a new medication or tapering off an old one, avoid “doctor-speak” and make sure the patient understands what you’re communicating. Whenever possible, send patients home with a printout summarizing the appointment and directions you’ve given.
—Manage expectations. If you’re prescribing a new medication or therapy, try to offer realistic expectations on how long it may take before the patient notices a result and how likely they are to see that benefit.
—Avoid stereotypes. There are so many incorrect stereotypes and myths in the medical world: about people of color, women, LGBTQ+ patients, people who are overweight, or anyone who takes opioids. For instance, many medical officials still believe the myth that individuals of color have a higher pain threshold. A good doctor will come into a new patient appointment without any preconceived assumptions.