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Chronic pain: A hidden epidemic

Created date

October 22nd, 2015
chronic pain chart
chronic pain chart

The burden of chronic disease on people in this country may seem to be mainly due to heart disease, cancer, or diabetes. Although these diseases certainly affect people’s lives, there is another problem that has emerged as a significant public health issue.

That problem is chronic non-cancer pain (CNCP). According to a report from the National Academies’ Institute of Medicine (IOM), CNCP is the most prevalent, disabling, and expensive public health condition in the U.S. CNCP is estimated to affect more than 100 million people and to cost society up to $635 billion in medical treatment and lost productivity—more than heart disease, cancer, and diabetes combined. Approximately 50% of people in the U.S. suffering from persistent pain are failing to control it with treatment and continue to have diminished functioning and a poor quality of life, according to the American Academy of Pain Medicine. 

Seniors and pain

“Probably the most common reason for persistent pain in seniors is arthritis,” says Nathan Wei, M.D., board-certified rheumatologist with the Arthritis Treatment Center in Frederick, Md. Over half of seniors report doctor-diagnosed arthritis, according to the Centers for Disease Control and Prevention (CDC). Back pain is the most common, with knee pain coming in a close second.

“Along with arthritis, chronic back pain in seniors can come from spinal stenosis, which is when the spinal column narrows and puts pressure on nerves,” says Matt Narrett, M.D., chief medical officer for Erickson Living communities. 

Treating pain with medications

Side effects from medicines can be amplified in older adults because of age-related bodily changes, concurrent health conditions, or interactions with other medications.

Acetaminophen (Tylenol) is very safe and thus a popular choice for first-line treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) have also been effective for many people, but these drugs—including over-the-counter aspirin, ibuprofen, and naproxen—can have adverse reactions, especially in people over 65. “NSAIDs can affect the kidneys or cause bleeding in the gastrointestinal tract—sometimes, without any warning or prior symptoms,” Narrett says. “Take the lowest recommended dose and follow your doctor’s guidance.”

Antidepressants such as SSRIs (selective serotonin reuptake inhibitors) or SSNRIs (selective serotonin norepinephrine reuptake inhibitors) have been found to lessen pain. “Antidepressants can cause dizziness and the likelihood of falls. The same is true for narcotic pain relievers and muscle relaxants,” Wei warns.

If you are taking medications that have dizziness or drowsiness as a side effect, take measures to avoid falls. “Reduce household clutter, remove loose rugs, improve lighting, wear sturdy shoes, and use grab bars,” says Judith Kahn, M.D., a physiatrist and pain management specialist in New York, N.Y. 

Over-the-counter remedies

Topical treatments such as hot or cold packs, creams, or ointments are fairly safe options. “The most frequent side effect is skin irritation,” Kahn says. “There are also prescription creams that work well for some people with joint or muscle pain.”

Oral herbal remedies and dietary supplements touting pain relief abound on store shelves. Glucosamine/chondroitin has received a lot of attention for relieving pain and improving mobility. “I’ve sometimes recommended glucosamine/chondroitin over the years,” says Carolyn Dean, M.D., a naturopathic doctor and medical advisory board member for the Nutritional Magnesium Association. “Glucosamine was originally studied in dogs and seemed to be beneficial. Human studies, on the other hand, had inconsistent results.” 

The supplement that Dean says she’s had the most success with is magnesium. “This mineral is not always easily absorbed, so people should consult with their doctors before taking magnesium or any other supplement,” she says.

“In over-the-counter products, the focus has shifted to collagen,” Dean continues. “Collagen is advertised to be especially good for joint pain. Rather than take a supplement, I advise some patients to get collagen from bone broth,” Dean adds. 

Other solutions

Pain can restrict movement and sap your motivation to be active. But being active may be the best prescription for relief. Physical therapy can often help you safely increase your activity. “A therapist can teach you how to strengthen your muscles and improve flexibility,” Kahn says. 

Physical therapists can also use heat or cold therapies. Work with your doctor to find a qualified therapist. “I have found that there can be a marked difference in the quality of therapy offered,” Kahn cautions.

Being even just a little more active has other benefits. “It can be hard to keep your spirits up when you deal with pain on a daily basis,” Narrett says. “Going for a walk can help lessen pain because it helps lift your mood.” A recent study showed that a simple walking program relieved chronic lower back pain as much as formal muscle-strengthening programs.

“Pilates, yoga, tai chi, and chair classes are also good ways to treat pain,” Kahn says. “Any activity should be started only with your doctor’s guidance.”

Some people find chiropractic services, acupuncture, acupressure, massage, or transcutaneous electrical nerve stimulation to be effective. Although these treatments don’t necessarily cure the underlying reason for pain, they may help relieve muscle tension and stress.

Toughing it out 

Despite its prevalence, CNCP is under-recognized and undertreated, according to the IOM, and many of today’s seniors may live with untreated pain because they value courage and self-sufficiency. “Being honest about your level of pain can help you and your doctor develop an individualized treatment plan,” Narrett says. “You may find that you can be more active and increase your enjoyment of life.”