Let me cut to the chase: Chronic pain is not a normal part of aging! You should not have daily pain just because you are over 50.
I can’t tell you how many patients I have who believe that aches and pains are what one should expect once you become middle age. Now, it is true that occasional aches and pains come with aging — typically in our knees, hip, and feet. This is due to wear and tear of our bones — they start to deteriorate over time, and joint spaces narrow. That can cause pain and stiffness. And most of us experience a headache at least once a year. I’m not talking about these instances. Chronic pain is pain that exists every day for at least six months. And if you have such pain, you need to get a proper diagnosis and care plan.
Take for example a recent patient I saw in clinic last year. “Bernice” (not her real name) is 60 years old, and her husband suffers from kidney failure and recently needed to go on dialysis. Bernice has become a caregiver shuttling back and forth to medical appointments. She opted for early retirement to help with his care. A few months prior to her clinic appointment, his condition had deteriorated. Bernice came to clinic complaining of a headache and general muscle aches. “I hurt all over” was her comment to me. Her labs results were normal, and her X-rays didn’t show anything out of the ordinary. Her primary doctor had been prescribing ibuprofen but according to Bernice, “it doesn’t seem to work and it upsets my stomach. I guess I’m just getting old and it’s something I just have to l live with.”
Bernice is not typically a patient of mine so we ended up spending much of the visit talking about her family situation. She remarked how she isn’t getting enough sleep, she barely finds time to eat, and she states, “I can feel the stress in my body.” “I have to do it all myself — no one helps me.”
It turns out Bernice is depressed and that is causing her generalized pain. The headache is a classic tension headache. With the proper dosing of an antidepressant, involvement of social work, and referral to behavioral health experts on stress-reduction strategies, Bernice is doing much better. At a visit a few months ago, the headache is gone, and her pain is now infrequent. And she understands why she gets pain, and knows when to seek help.
Pain is multifactorial and the mind plays a powerful role. Stress, depression, and mental health are critical components in the pain pathway. In order to better manage chronic pain, we need to remove the barriers to diagnosis and treatment. Patients need to understand that chronic pain is not normal just because we get older, and doctors as well need to understand the role of the brain in pain. Many of my colleagues will just dismiss chronic pain in the elderly, as it’s all arthritis — which it is not!
There’s also the issue of addiction — which we cannot ignore. Many physicians are concerned about patients becoming dependent on pain medicines and worried about what they perceive as increased scrutiny by licensing authorities. And I have had many patients that don’t ask for anything for pain because they “don’t want to become addicted.”
We need to do a better job of addressing chronic pain from a patient’s perspective. And that includes more research around the neurobiology of pain. Having people endure daily pain just is not acceptable, and no one should consider it normal.
