Pain is a common symptom of many medical disorders, typically signaling the presence of damage to tissues. Although pain is unpleasant, it is also a beneficial tool to facilitate healing. Pain which persists after recovery is expected to have taken place or which exists in the absence of tissue damage is termed chronic pain. The International Association for the Study of Pain (IASP) has defined chronic pain as that which lasts for longer than three months. By definition, chronic pain cannot be treated and cured in the conventional biomedical sense; instead, the patient suffering from the pain must be given the tools to manage their long-term pain to an acceptable level.
In Canada, studies of chronic pain have shown that it is a disorder widely documented. Among people living in private households, 16% of those aged 18 to 64 and 27% of seniors reported chronic pain. The prevalence rose to 38% for seniors living in long-term health care institutions. The three most common pain sites in older people are the back, leg/knee, and hip.
Pain management should involve a multidisciplinary approach, including multimodal medications, selected interventions, physical therapy, and rehabilitation and psychological treatments. While pain control requires pharmacological intervention in most patients, non-pharmacological interventions can have an added benefit and should be considered regularly. There is evidence that daily physical activity involvement will reduce older adults’ discomfort with chronic pain and improve their functional capability. Assistive devices are prescribed to prevent further impairment, compensate for a range of motion restrictions, promote safety, manage pain during self-care and other daily living activities.
Assistant devices cover a wide variety of products that improve or promote function or the ability to engage in activities. Assistive devices are used in rehabilitation to facilitate the process of compensation and restoration of function.
Assistive devices like canes, crutches, and walkers can improve balance, assist the propulsion, reduce the load on one or both lower limbs, and transmit sensory cues through the hand(s). These devices also allow the user to obtain the physiological benefits of upright posture and maneuvering in places inaccessible to the wheelchair and warn passersby that the user needs special considerations. The device must fit properly to enable the user to walk with the least effort and the greatest comfort. Complications in the hand, arm, shoulder, or axilla are not uncommon with crutches and canes. While the use of an assistive device may only be a marker of muscle weakness or impaired balance, the assistive device itself may directly increase the fall risk. As most patients receive their assistive device without consultation or instructions from a medical provider, assistive devices should be evaluated regularly for proper fit and use.
The vast majority of non-specific low-back pain is treated conservatively with rest, analgesics, anti-inflammatory medicine, physical therapy, manipulation, and, in many cases, orthoses. Lumbar support continues to be one of the most effective ways of treating injury and disability caused by low back pain. Many patients, regardless of the exact mechanism of action, can obtain some level of pain relief.
Each muscle and joint of the upper extremity is subject to overuse. Repetitive trauma, forceful muscle contractions, and undesirable posture put the tuned balance and biomechanical of our upper extremities at risk. Surgery can help in these conditions but should be used only after conservative measures with orthoses, rest, therapy, and appropriate anti-inflammatory drugs have been tried. Proper orthoses are paramount to the care and treatment of many of the afflictions encountered by our limbs.
Occupational therapy can help patients with chronic pain to improve their involvement in daily activities. A significant feature of such treatment is the prescription of assistive devices. Early occupational therapy intervention to administer assistive devices and include strategies to stay active despite pain can be beneficial.
In summary, there is evidence that assistive devices:
- support community living,
- reduce functional decline,
- reduce care costs, and
- reduce pain intensity relative to older people not provided with devices.