Physical therapy is just one of the many pain control options offered by specialists today.
Although older adults are more likely to experience pain, it is not a “symptom” of aging, and it should not be accepted as inevitable. Unfortunately, pain has often been undertreated in older adults, but pain relief is an essential part of good healthcare. Untreated pain can cause a significant decline in the well-being and quality of life of older adults, resulting in fatigue, depression, anxiety, withdrawal from social life, and reduced ability to perform the activities of daily living.
Pain is a complex mechanism. It is a signal to the brain that something threatens the well-being of the body. The process is usually quick and simple: we touch a hot stove…the pain message rushes to our brain…our brain tells our arm to pull our hand away as rapidly as possible…and we do! We could not survive without this alert system. In addition to the physical response to pain, the latest research is showing a complex mechanism of brain, spinal cord and hormonal reactions that can modify or augment pain. Acute pain is limited in duration, and is the result of a specific injury or short-term illness (such as a burn, surgery, appendicitis or an ear infection). Chronic pain is ongoing—sometimes for years—and can be the result of an incurable condition (such as arthritis, migraine headaches, neck or back pain, irritable bowel syndrome or diabetic neuropathy). Sometimes chronic pain is caused by damage to the nerves themselves and is worsened by the brain, hormones, stress and other factors.
Special concerns of older adults
Certain painful conditions are more common as we grow older. These include arthritis, osteoporosis, fractures, angina, shingles, and circulatory problems. An older adult may suffer from a combination of conditions, each condition having its own pain control challenge. However, while older adults are more likely to experience pain, they are the least likely to ask for or receive relief. They might believe that they are “just getting older” or “don’t want to be a bother.” They may avoid pain medication, fearing addiction or a reduction in function. People who have Alzheimer’s disease or other dementia may be unable to clearly communicate when they are experiencing pain. Caregivers should learn to interpret certain signals, such as slower movements, decreased function, irritability or other behavior changes. One of the best things patients can do to reduce arthritis pain is exercise. Stiff joints need to be moved, obviously movement can hurt a bit at first, go slow and consult a specialist.
Pain management: know when to seek help
Never assume that nothing can be done. Since each case is different, it is important to work with the healthcare provider to determine the most effective treatment or combination of treatments. Here are some of the many options:
Medication Today, modern pain control specialists have a wide array of medications to offer patients. The main classes of pain-relieving drugs are:
- Morphine, codeine and related opioid drugs, used to manage moderate to severe pain
- Over-the-counter pain medications, including aspirin, ibuprofen and acetaminophen
- Antidepressants, used to treat some types of nerve pain
- Muscle relaxants, for use when pain results from muscle spasms
- Corticosteroids, which lessen painful inflammation
- Topical medications, applied to the skin for burns, arthritis, oral sores, blisters and other conditions
Seniors should be aware that medications can affect us differently as we grow older. Decreased digestive and kidney function may cause substances to be excreted more slowly, which may allow a toxic dose to build up. Some side effects, such as gastrointestinal irritation, dizziness and constipation, become more common in older adults. In addition, many seniors take medications for multiple conditions, increasing the possibility of adverse drug interactions. It is important that a person’s pharmacist and all healthcare providers are aware of all medications being taken, both prescription and over-the-counter.
Physical treatments Medication is not the only option for pain relief. Physical therapists and pain specialists offer a variety of treatments, such as massage; immobilization with cast or slings; heat and cold; electrical current devices; therapeutic exercise; and alternative therapies, such as acupuncture. Surgery on the nerves may also be indicated for extreme pain.
Pain isn’t “all in our head” The way we think about pain makes a difference, however. Stress and anxiety magnify the perception of pain, which in turn increases stress and anxiety. To break that cycle—and to gain power over pain through thinking of it in a different way—some of the following techniques may be helpful:
- Education about the nature of one’s pain, what causes it, and what can be done about it
- Relaxation techniques, such as yoga, breathing exercises, meditation or stress management classes
- Biofeedback instruments, which help the patient learn the “relaxation response”
- Distraction techniques to help the brain transcend pain messages
Pain threatens the quality of life of older adults, but a multidisciplinary approach that includes physical, emotional and spiritual care can help break the “pain cycle” and let older adults feel more in control of their condition. Guess what else helps with pain? Movement and exercise? Are our clients afraid to move or exercise because of pain. A Physical Therapist is a great place to start to begin a program safely.
Richard Ueberfluss, PT