Recent advances in pain science

What do we know about pain and ageing?

We know that persistent pain affects around 20 per cent of Australians. This statistic is similar in the older adult population, however, there are challenges regarding the diagnosis and treatment of persistent pain that are unique to the older population. The most common of these challenges is the incorrect assumption that worsening, or more frequent pain is an inevitable part of ageing. Indeed, there are many common misconceptions about pain and ageing, that have profound implications both for research and health care. Understanding and deconstructing these misconceptions have important implications for quality of care and improving quality of life for the older population.

What does the research tell us about pain and treatment among Australian aged care recipients?

A great deal of research aims to evaluate how medications and surgical treatments for acute pain can be delivered most effectively. In some instances, medications can be highly effective and are part of best-practice guideline care with regular review and monitoring. However, large population studies have shown limited efficacy for many medications in cases of persistent pain, such as for back pain and osteoarthritis related pain.

All pain is real, and deeply personal

Many people believe that medication and surgery are the only options for pain management, and if these fail, nothing more can be done. This is simply untrue – there are many things that can be done to help manage pain, regardless of the cause or duration of pain. We now know that pain is not always a sign that something in the body has been damaged, particularly in cases of persistent – chronic – pain. Pain is a protector, and sometimes pain can become overprotective and unhelpful.

The human nervous system is neuroplastic, meaning that we can readily adapt to changes in our environment, even as we age. This means that the nervous system can change, and pain can resolve. However, this phenomenon can cut both ways, and the nervous system can become overly sensitive causing increased pain.

Have there been any recent advances in pain science?

There have been many tremendous advances in the pain sciences in recent years. The 2021 Nobel Prize in Physiology or Medicine was awarded for the discovery of cellular receptors that communicate information about thermal, mechanical, and chemical danger to the brain. This work was important to provide evidence that pain is not always a sign of damage, but rather of potential danger.

Studies have shown how context, such as visual and auditory stimuli, can radically change how we experience pain. For example, a red light illuminated while a noxious stimulus is administered to the skin results in an intense perception of pain, while a blue light illuminated with the same noxious stimulus results in a feeling of mild discomfort. Where a blue light may represent safety – and thus not warrant any alarm – a red light may be considered an indicator of danger, thus triggering a protective pain response.

What innovative pain treatments are available?

As previously mentioned, misconceptions about the neurophysiology of pain can have profound negative impacts on the experience of pain. Recent research has shown positive effects on both pain intensity and quality of life from educational interventions that aim to change how people conceptualise pain. Broadly termed pain science education, these interventions aim to facilitate conceptual change about pain, such that individuals have a contemporary understanding of both the neurophysiology of pain, and self-management strategies to improve function and quality of life. These interventions may include components such as exercise, psychological therapies like cognitive behavioural therapy, mindfulness-based therapy and hypnosis, and more recently, have integrated virtual and augmented reality technologies. By changing the way people perceive the relative safety and danger of their body and environment, their perception of pain can also be modified.

Can you provide any tips or resources for aged care staff supporting older people to manage their pain?

All pain is real, and deeply personal. Even in instances where pain presents in the absence of any tissue damage, individuals should be believed when reporting pain, and factors that are contributing to a perception of danger should be taken seriously.

There are many resources and practical tools for clinicians and carers working with people in pain. PainAustralia is the national peak body working with governments, health professionals and consumer bodies Australia-wide to advocate for equitable access to pain management. PainRevolution.org provides free resources about the complex concepts I presented herein, relevant both for clinicians and people experiencing pain. Up-to-date research about advances in pain science from research institutions can be found at the Persistent Pain Research Group at the University of South Australia or NeuRA at the University of Sydney.

At the Registry of Senior Australians, we are working toward understanding the benefits and risks of pain medications to improve quality of care throughout the aged care sector (rosaresearch.org).

Dr Brian Pulling is an epidemiologist with the Registry of Senior Australians at the South Australian Health and Medical Research Institute

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