Older Age Linked to Decreased Perception of Acute Visceral Pain

Effect of Age and Pain Significant

Pain is one of the most common reasons patients visit the emergency department, the study authors write. Aging, along with other factors such as sex and ethnicity, could affect pain perception, which is an important part of triage to provide an adequate diagnosis.

The study included 15 670 patients aged 18 years and older presenting to 2 hospital emergency departments with 1 or more of 6 painful diagnoses, including renal colic, pancreatitis, appendicitis, headache/migraine, dislocation and extremity fracture. Demographic data, triage information, medical procedures, and final diagnoses were collected in real time using the same computerized system in both facilities.

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Asked by nurses to evaluate their pain intensity on a scale of 0 to 10, with 10 being the worst possible pain, patients reported a mean pain intensity of 7.7.

Age had a significant linear effect on pain perception for patients with renal colic, pancreatitis, appendicitis, and headache/migraine diagnoses (effect size [ES] = 0.09, 0.18, 0.08, and 0.11, respectively). All showed linear decreases in pain intensity levels across age groups of 18 to 44 years, 45 to 64 years, 65 to 74 years, and ≥ 75 years (P < .05 for all).

Mean differences in pain intensity levels between young adults and those aged ≥ 75 years were 0.79 (95% confidence interval [CI], 0.5 – 1.1) for renal colic, 1.1 (95% CI, 0.7 – 1.4) for pancreatitis, 0.70 (95% CI, 0.2 – 1.2) for appendicitis, and 0.86 (95% CI, 0.6 – 1.1) for headache/migraine.

Study data also showed that women exhibited greater pain scores than men for pancreatitis, headache/migraine, and extremity fracture (ES = 0.10, 0.06, and 0.05, respectively).

“Prior studies have noted differing pain perceptions in patient populations of varying ages. However, this was a particularly large study, which helps give us a deeper understanding of this topic,” Mark Reiter, MD, MBA, FAAEM, president of the American Academy of Emergency Medicine, told Clinical Pain Advisor.