Pain in old age: Drugs, care, touch
“What works for whom how long how much under which circumstances” should be the starting point for the exploration of a difficult situation. The management of pain in the Elderly is challenging. Multimorbidity is the rule, not the exception, and as a consequence there are complex and difficult prescribing regimes. These prescribing regimes limit the range of possibilities for analgesic prescribing – adverse effects on bowel function, alertness, lucidity, renal function are common and the risk of falling increases. Non-pharmacological methods provide an alternative. They include psychological strategies (attention control, mindfulness) and touch-based interventions (manual therapy, acupuncture). Mind-body therapies like Tai Chi or specific rehabilitation strategies like Bobath training also come into play.
They are therapist-delivered therapies. This links to another important field – how is the division of labour organised? What is the status for touch-based interventions? How is the borderline between touch as part of care for basic physical functions and specific therapeutic interventions configured? And where do these intersections and boundaries feature in the division of labour, in the practice of care, delivered by many people and many organisations?
The lived experience of vulnerable older people, experts by experience, and the knowledge of experts by profession will be brought together in a panel. It will have a practical and pragmatic dimension by anchoring the investigation in the sociomaterial realities of older people experiencing pain and the medical and organisational responses to this challenge. It includes multiple levels of enquiry, from neurophysiology to care sciences to management studies.
These positions should be considered in the selection of panel members and the orchestration of the discussion.