Chronic Pain-Seniors

CHRONIC PAIN is a common issue among elderly people. However, they often ignore and deal with it in their ways till the matter worsens. For those suffering from arthritis, diabetes, neurological diseases, cancer, or even cardiovascular issues, this is common. Back pain is the most common among seniors. Also, vertebral compression and osteoporosis, because of ageing are the cause of pain in post-menopausal women. Even Vitamin D deficiency emerged as a significant cause of back pain in women. Most of the seniors learn to live with pain and describe it differently than young people. They use words such as discomfort and aches and may visit doctors for options to reduce pain through prescription drugs. Few explore alternative therapies for pain management. However, some special challenges exist for effective pain management in seniors, especially when they are on regular medications.

Physiological Changes

The physiological changes come into play and should be understood to help them with pain management. Also, for those with cognitively impaired, some special methods are needed to understand and manage their pain, as may not be able to express it, unlike others. The liver of older adults is smaller, with less blood circulation. These altered liver conditions and certain regular medications can affect the body’s metabolism. Also, seniors have higher body fat and reduced water and muscle mass. Even renal functions can be reduced after a certain age and affect many body functions.

For seniors with co-morbidities, an increased risk of drug-related adverse side effects is a reality. Even physiological factors such as depression, loss of independence, economic constraints, etc., are challenges affecting pain management in seniors. Physiological issues may be linked to a general resignation to the pain as part and parcel of old age and not wanting to do anything about it. For those with mobility issues, it also means relying on someone to go for tests, diagnosis, and subsequent physiotherapy sessions. Even though seniors may not explicitly express their pain, it is seen and felt in many ways.

Pain Behaviours

When suffering from pain, the behavior of seniors changes in many ways, both physically and psychologically. Some behaviours that people around can observe are:

• Changes in mobility and gait.
• Restricted movement
• Changes in sleep patterns
• Changes in appetite
• Irritation or aggression
• Face grimaces
• Rapid blinking, moaning, or groaning.

When you observe such behavior, it is better to approach the doctor and get a proper pain assessment done to understand the root causes. The treatment also depends on family and medical history and the severity of the pain. It may include physical examination, lab tests, x-rays and other imaging tests as needed. Sometimes, the pain is due to a specific physiological issue that is easily treatable and disappears once you address the root cause. In some cases, though, the pain may be something you can not eliminate totally due to a combination of issues and would need a pain management plan.

Treatment Options

The non-pharmacological options include physiotherapy, interferential Therapy (IFT), ultrasound physiotherapy, acupuncture, massage therapy, etc. Even topical application of pain relief creams, patches, etc., are part of non-pharmacological options. Many alternative therapies such as biofeedback, music therapy, meditation, yoga, aromatherapy, etc., are part of non-pharmacological treatments.

Cognitive behavioural therapy helps patients learn coping skills through various techniques to increase their physical activities and psychological confidence. The only issue with non-pharmacological treatment options is the time, which can be long duration. And there is the likelihood of patients losing out on their commitment and confidence to keep going.

The pharmacological options include non-steroidal anti-inflammatory drugs (NSAID), anticonvulsants, antidepressants, and more. Managing side effects is one of the special challenges for those on medications. A holistic approach of a combination of therapies that suit every individual differently is needed. There cannot be a one-size-suits-all approach for pain management in seniors. An invested discussion, diagnosis, and carefully considered treatment plan can go a long way in helping seniors overcome the pain or manage it completely.

Friends, if you are a senior yourself or someone who is taking care of a senior person then this article will be definitely useful for you.

Waiting for your views on this blog.

Anil Malik

Mumbai, India

25^th May 2023