The Epidemiology of Pain During the Last 2 Years of Life

Alexander K. Smith, MD, MS, MPH

Division of Geriatrics
University of California, San Francisco
San Francisco Veterans Affairs Medical Center
San Francisco, CA

As patients move toward end of life, healthcare goals generally shift towards improving or maintaining quality of life and away from curative treatments. In particular, one national survey found that freedom from pain was the most important health-related consideration for patients at the end of life. Studying pain as death approaches, however, is confounded by many logistical challenges, including biased sample pools or the need for indirect observations by proxy. The recent Health and Retirement Study on clinically significant pain among community-living older adults directly examined the prevalence of pain in the 2-year period prior to death. Here, Dr. Smith summarizes the findings of this study and urges clinicians to anticipate an increase in pain levels as death nears, consider referring elderly persons with difficult-to-manage pain for specialist care, and take special note of patients with arthritis, who often have significantly higher pain levels compared with those who do not have arthritis.

References

1. Smith AK, Cenzer IS, Knight SJ, et al. The epidemiology of pain during the last 2 years of life. Ann Intern Med. 2010;153:563-569.
2. Steinhauser KE, Christakis NA, Clipp EC, et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 2000;284:2476-82.
3. Lynn J, Teno JM, Phillips RS, Wu AW, et al. Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Ann Intern Med. 1997;126:97-106.

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