The Pain Clinic for Older People.

Abstract

Multidisciplinary Pain Clinics have an established role in the management of persistent pain, however there is little evidence to support this approach in an older population. This study describes the characteristics and pain outcomes of patients attending a pain clinic designed exclusively for older people. Retrospective audit of outcomes of the Pain Clinic for Older People (PCOP) from 2015-2019. Response to treatment was determined by change in Brief Pain Inventory scores (BPI) at initial attendance and following a treatment program. Clinically meaningful improvement was defined using the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) consensus criteria of ≥ 30% improvement in average pain and 1-point improvement in pain interference. Results were compared to the national benchmark collated by the electronic Persistent Pain Outcomes Collaboration (ePPOC), which reports the combined results from 67 participating Australian and New Zealand (AU/NZ) pain services. PCOP patients had a mean age of 80.5 years and had high rates of frailty (84%), cognitive impairment (30%) and multimorbidity. Significant reductions in BPI average pain and BPI pain interference scores were achieved. Clinically meaningful improvement in BPI average pain was achieved in 63% attending the PCOP aged 65-74 years, and 46% in patients aged ≥ 75 years, which met the national benchmark set by ePPOC of 40% for both age groups. Clinically meaningful improvement in BPI pain interference was achieved in 69% in 65-74 year-olds attending PCOP and 66% of those ≥ 75 years, comparable to the ePPOC benchmark of 71% and 65% for the respective age groups. . PCOP clients achieved significant and meaningful improvements in their pain outcomes that satisfied the national benchmark. Advanced age, cognitive impairment, frailty and multimorbidity should not be regarded as barriers to benefit from a pain clinic specifically designed for older people.