One in three adults over the age of 65 is affected by body pain; often due to joint and back problems. According to the Statistics Department of Malaysia, the ageing population is growing quickly.
The rising incidence of body aches and pain among the elderly population not only has a significant impact on our healthcare system but also imposes an increasing burden on our society’s resources.
“Doctor, I am still in pain even though I’ve been taking painkillers every day for the past year. Can you give me a stronger medication?”, Madam Fatin said miserably.
Although pain is an uncomfortable sensation, it is one way for your body to tell you that something is not right, much like a warning alarm.
It can take weeks to months for our bodies to heal and recover but there are also some conditions that may not go away completely.
Individuals who experience persistent pain for more than 3 months are considered to have chronic pain. Untreated or under-managed chronic pain is often associated with complications such as depression, loss of independence and poor quality of life.
Why Do the Elderly Commonly Experience Body Pain?
There can be several causes of chronic pain in the elderly population. The joints, feet, legs and back are some of the areas typically affected by pain.
Some of the most commonly identified causes of chronic pain are:
- Osteoarthritis (when joints become worn out)
- Osteoporosis (low bone density and bone quality)
- Back pain (vertebral compression fractures)
- Post-herpetic neuralgia (PHN)
- Painful diabetic neuropathy (PDN)
Osteoarthritis
Osteoarthritis is the most common joint problem in the world. The older we grow, the higher the chances of developing osteoarthritis due to the natural wear and tear of our joints and bones.
Athletes are also at a higher risk of developing osteoarthritis as their joints are subjected to more overuse as well as repeated stress. In addition, females also have a higher tendency to be affected by osteoarthritis compared to men.
Osteoporosis
Osteoporosis is the condition in which one’s bone strength is compromised and becomes more brittle.
Patients who suffer from this condition are at a higher risk of having fractures; even from minor falls and minimal impact. The most common sites for fractures are the forearm, back and hip bones.
Back pain (vertebral compression fractures)
Post-menopausal women i.e. those who have reached menopause, with osteoporosis have a higher tendency to also experience fractures involving the spine, specifically vertebral compression fractures.
Post-herpetic neuralgia (PHN)
PHN is a painful complication of shingles. However, not everyone who has been diagnosed with shingles will be affected by this.
That being said, in adults over the age of 60, half of those who have had shingles are likely to be affected by PHN.
Painful diabetic neuropathy (PDN)
Unfortunately, Malaysia is one of the countries with the highest number of diabetic patients in the world and this number has been steadily increasing each year.
Painful diabetic neuropathy is not an uncommon complication, especially among older diabetic patients. As the number of diabetic patients increases, chronic pain due to painful diabetic neuropathy is proving to be more and more common.
Pain Killers in Older Patients
Managing pain in elderly patients has been known to be challenging.
Older patients, especially those with heart, kidney and/or stomach issues, are unlikely to tolerate painkillers well. Changes to our body and its functions are inevitable with aging.
Many pain medications are broken down and metabolised in our kidneys and liver. As we age, they are no longer able to work as well as they did in years past. Hence, there is a higher risk of experiencing side effects and toxicity from medications, including painkillers.
Paracetamol, also known as Acetaminophen, is the preferred pain medication for the elderly.
However, great caution must be taken when administered to individuals such as those with liver or kidney disease, malnutrition or a history of alcoholism.
Other pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) must also be used with caution. These types of analgesics should only be used for a short period and must be taken with stomach-protecting medications.
Refrain from using two NSAIDs together at the same time to minimise the risk of having more side effects. Certain high blood pressure medications such as ACE inhibitors should also be avoided in people taking NSAIDs. In such cases, they should take either an alternative blood pressure medication or a different pain medication.
Evidently, finding the appropriate medication and dosage might require a significant amount of time due to tolerability, efficacy and safety.
Effects of Inadequate Pain Control
In Madam Fatin’s case, it is not hard to imagine that her chronic pain has significantly impaired the quality of her life.
As part of the aging process, our brains undergo several neurochemical changes, resulting in a higher sensitivity to pain and a lower pain threshold. Hence, more care and patience are needed and warranted for patients who are of advanced age.
In the absence of proper treatment, persistent pain can contribute to an increased risk of developing delirium – a medical condition that frequently affects older patients. It can manifest as confusion, disorientation, a sudden change in behaviour, disorganised thinking and loss of focus.
Can We Improve Body Pain Without Medications?
Yes, in many cases it is possible to alleviate body aches and pain without the help of pain medications.
Having said that, a combination of physical, psychological and pharmacological (medications) treatment would be the most effective approach in managing pain.
For overweight and obese individuals with joint pain, one of the steps that would make the greatest impact would be to lose weight which would ultimately reduce the stress of the body’s weight on the joints. How to know if one is overweight and obese? This BMI calculator (click here) is useful to calculate the body mass index (BMI).
5 Tips You Can Try at Home to Reduce Body Pain
The 5 activities you can do at home to improve body pain are:
- Yoga (remember that you are never too old for yoga!)
- Tai Chi
- Stress-relief music therapy
- Aromatherapy
- Temperature treatments (hot/cold packs applied to painful joints)
Yoga
Yoga can prove to be very helpful for seniors. There are certain yoga poses that are specifically tailored for seniors, which focus on slow and controlled movements. It is crucial to find the right instructor that can personalise the sessions to one’s needs and fitness level.
For starters, small, simpler movements that involve different body parts, such as tilting the head from side to side, rolling the shoulders, and gently arching the back are a good way to ease into yoga.
If balancing is difficult, it is a good idea to place your hand on a chair or wall for support. If you have joint or flexibility issues, it is recommended that you consult your doctor first before attempting anything that may cause discomfort.
Tai Chi
Tai Chi first originated in ancient China as a form of martial arts.
Today, it has developed into a soothing wellness practice that harmonises movement and meditation.
Tai Chi is popular especially among the elderly in Asia as a form of exercise due to its benefits in improving their physical and mental health.
The gentle and controlled movements help strengthen the muscles, enhance stability and balance as well as improve overall body flexibility.
Other than the physical benefits, Tai Chi is also well-known for boosting one’s mental health.
Stress-relief music therapy
While music therapy is not the definitive treatment for pain management, it can be a good supplement to medical treatment.
According to a research involving 524 seniors who were undergoing stress-relief music therapy, they reported positive outcomes in terms of alleviating chronic pain.
Music therapy can be tailored to each individual’s preference, such as classical music, live music, instrumental and other slow-tempo genres.
On top of being a more economically friendly form of therapy, seniors can also reap the other benefits of music therapy such as having room for creativity and mental stimulation.
Aromatherapy
Aromatherapy is the use of aromatic plants, specifically through the use of essential oils, to improve well-being. There are multiple ways of using these essential oils, ranging from inhalation, baths and direct skin application to compresses.
Aromatherapy has been shown to be an effective method to alleviate pain, mental stress, depression and anxiety among older adults.
Temperature treatments (hot/cold packs applied to painful joints)
Temperature treatments, also known as thermotherapy and cryotherapy, are the application of heat or cold temperature to joints. This can be done using packs, towels, wax, etc.
How do heat or cold work to improve pain in seniors, especially those with osteoarthritis?
The heat helps to improve blood circulation and loosen the muscles. Cold therapy, on the other hand, is useful in numbing the pain, reducing swelling, constricting blood vessels as well as blocking nerve impulses to the joint.
Massaging the affected joints with ice for 20 minutes, five days a week for two weeks, may improve leg muscle strength, enhance knee mobility and reduce the time taken to walk 50 feet compared to having no treatment at all.
Treating Pain in the Elderly
Advancing age is known to be linked to higher incidences of painful conditions.
Anyone suffering from constant pain despite being on treatment should be reassessed to explore the reasons for failing to respond to therapy as there could be a more serious underlying cause that has yet to be identified.
Hence, in our example, Madam Fatin’s condition should be re-assessed carefully.
Over-reliance on medications is not ideal. Rather, a better approach would be one that combines physical, mental-behavioural and pharmacologic (medications) therapies which would result in greater potential benefits in managing long-term pain.
It takes a multi-disciplinary medical team with a holistic approach to properly and sufficiently manage chronic pain among elderly individuals.
Age should not, however, be seen as a barrier to successful pain management outcomes.
If you or your loved ones are experiencing constant pain consider a consultation with a physical medicine specialist to improve physical function while avoiding painful and uncomfortable activity.
References:
- https://www.uptodate.com/contents/treatment-of-chronic-non-cancer-pain-in-older-adults
- https://bestpractice.bmj.com/topics/en-us/694
- Brocklehurst’s Textbook of Geriatric Medicine and Gerontology 8th Edition, by Howard M. Fillit, Kenneth Rockwood, and John B.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794132/
- https://pubmed.ncbi.nlm.nih.gov/17575490/
- https://www.nytimes.com/2023/01/25/well/move/yoga-seniors.html
