Age differences in the experience of cancer pain

The aim of this dissertation is to elucidate age-related patterns in the multidimensional experience of cancer pain. Chapter 1 presents a literature review of age-related patterns in cancer pain, outlines the methodological limitations of existing literature and highlights gaps in our knowledge. Chapter 2 presents the first psychometric analysis of the Short-Form McGill Pain Questionnaire-2 in older and younger people with cancer pain. The weight of the evidence suggests that this tool is valid for use in older and younger people with cancer pain. Chapter 3 presents an analysis of age-related patterns in the experience of cancer pain across the biopsychosocial spectrum. Pain intensity, qualities, and interference did not differ across age groups but older patients were somewhat less likely to be prescribed an opioid. Comorbidity was associated with greater pain for younger, but not older people, and chronic nonmalignant pain was associated with greater pain for older, but not younger people. An age-related pattern in the supportive context of cancer pain based on health status factors may also be present. There were no age differences in depressive symptoms, but intrusive thoughts were associated with greater pain for younger but not older patients, suggesting a unique adaptive advantage of prior experience with health limitations among older, but not younger patients. Chapter 4 presents a preliminary investigation of the role of pain three months after breast cancer surgery in the relationship between age and depressive symptoms. In women with moderate-to-severe pain, age was not associated with depressive symptoms but in women with mild or no pain, younger age was associated with greater depressive symptoms. However, in women with neuropathic pain, younger age was associated with greater depressive symptoms, but not in women without neuropathic pain. The impact of pain was not age-related. High preoperative pain expectations may be a risk factor for pain three months after breast cancer surgery, regardless of age. In Chapter 5, results are integrated and discussed along with implications for future research and treatment.