By: Simone Steyn, SIFAR Research Associate

Chronic pain is a well-known public health concern resulting in a significant global economic burden. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Pain becomes “chronic”, when it is present for three months and beyond, and when pain has continued beyond the normal acute tissue healing process. Pain that continues beyond normal healing of an acute injury can lead to suffering, along with disability, helplessness, frustration, anxiety, and depression (amongst other things).

With advances in healthcare over time, older adults are living longer. However, this has come with the cost of what is known as multimorbidity - the development of multiple chronic diseases, which is increasingly common among older adults.

Chronic diseases among older persons often come with the side effects of chronic pain, either as result of a primary condition such as arthritis, or as a secondary side effect such as diabetic neuropathy from diabetes.

Chronic pain is often under-managed in many health systems globally, with the focus typically being on treatment through a biomedical approach via opiates and surgery. When chronic pain is viewed as a singular concept this becomes a problem, as it stems from a multidimensional network of factors which include biological alongside psychological, social and behavioural factors and treatment needs to incorporate this. The greatest contributing factors exacerbating chronic pain are stress, anxiety and depression. Through a vicious cycle, these states activate pain signalling through a complex neurobiological system which then causes depression and anxiety.

In the midst of the current pandemic, the vulnerability of older adults to COVID-19 may lead to increased stress, anxiety, depression, and loneliness among this population, with all these factors possibly contributing to increased chronic pain. It is therefore very important that long-term care facilities and/or family members looking after older persons take this into account and assist in the management of these psychological factors. Stress reduction techniques such a light exercise, mindfulness and meditation can help to lower stress levels, alongside effective social support, and interaction.

At SIFAR, I am currently completing a cross-sectional analysis to determine if an association exists between pain and poverty among older adults living in four communities in Cape Town, using data from a longitudinal SIFAR study called the Wellbeing Study. The four sites used for this analysis are: Khayelitsha, Bishop Lavis, Woodstock and Mamre.

Depending on the results of this study, SIFAR may develop a a randomised controlled trial focused on pain management techniques among older adults from selected sites in Cape Town. A 6-week educational and exercise programme called PEEP (Pain Education Empowerment Programme) will be used for both the intervention and the control groups. The intervention group will continue with weekly community peer-run groups after the initial programme has ended. These community peer groups will be included to help with the continuance of the techniques learnt in the PEEP course based on the hypothesis that the maintenance of newly learnt behaviours will help with the long-term reduction of pain.