"The Use of Algorithms in Assessing and Managing Persistent Pain in Older Adults" (March) offered an enlightening look at ways to maintain optimal levels of functioning in older adults. As a nursing student who's worked on the cardiac rehabilitation floor of an acute care facility during senior year, I've seen how chronic pain inhibits patients from performing activities of daily living and drastically slows healing.

Many older adults I've cared for were living independently prior to their admission for cardiac surgery but were discharged to a skilled nursing facility, mostly because chronic pain limited their ability to perform basic tasks.

Although I appreciate the need for better chronic pain control in older adults, I'm concerned about the idea of regimenting and objectifying largely individualized assessment and treatment plans. The classification of a patient's pain as mild, moderate, or severe is dependent on her or his ability to rate it accurately on a 0-to-10 scale-a highly subjective measure. I fear that instituting a rigid algorithm for pain control will continue to leave many older adults suffering from poorly controlled chronic pain.

Courtney L. Wright

Ellsworth, ME