Integrating Chronic Pain
It’s a difficult conversation; one I have all too frequently with my aging patients. We have to be realistic. There are times when a diagnosis of chronic pain means that, no matter what we try, we will never achieve 100% relief. Instead, we turn our attention to helping the patient become as functional and pain-free as possible within the parameters of his or her condition. We focus on maximizing the quality of life and integrating the reality of ongoing pain management.
- Acute pain lasts less than 30 days and is usually due to some injury or other event.
- Subacute pain lasts from a few weeks to a few months.
- Chronic pain lasts for six months or more without any improvement.
What are some common types of chronic pain in older adults? By far, the most frequent one that I see is pain due to osteoarthritis (also known as degenerative arthritis or degenerative joint disease), the most common form of arthritis.
How do you measure the degree of pain? The most commonly accepted pain measurement technique is a 0 – 10 scale. Zero means no pain at all, and 10 is the worst pain you can possibly imagine (patients who have had a joint replacement, kidney stone, open heart surgery or given birth can relate to a level 10 pain experience!). Nurses often use a graphic illustration of faces that go from happy to weeping to help patients assess their current pain.
- What is the quality and quantity of the pain?
- What makes it better or worse?
- What have you already tried?
- Is the pain affecting your ability to eat or sleep?
- How is the pain affecting your activities of daily living?
- Is the pain affecting your mood?
- First and foremost, Tylenol! For most people, to treat osteoarthritic and many other kinds of pain, the first line drug of choice is acetaminophen (commonly marketed under the brand Tylenol). Studies have proven it to be as effective as some narcotics in controlling pain and it is generally safe to combine with most other medications. But please check with your physician as there are some exceptions to this rule.
- Prescription pain relievers. Your physician will know if you need a narcotic medication to manage your specific type of pain. The important thing about taking medications--whether Tylenol or prescriptions--is to stay on top of the pain. They need to be scheduled and taken regularly, not on an as-needed basis. By the time you realize you need a dose, it’s probably too late. It takes about 45 minutes for your body to process the medication and feel the relief. For chronic pain, we often use a combination of a long-acting medication for overall pain management with a short-acting medication for breakthrough pain. I often see senior patients who are worried about becoming addicted to pain medications. Even though they may have a pelvic fracture, they don’t want to take a narcotic pain reliever. The fact is that it’s a long road to addiction. You have to be on consistent doses, multiple times a day for a prolonged period of time, before addiction and withdrawal could become concerns.
- Steroid injections and nerve blocks. These are administered by pain management specialists or trained physicians and can be very effective for some conditions.
- Surgery. We usually try to exhaust all other options before turning to surgical interventions. However, surgery is sometimes necessary and can be the best solution for certain conditions.
- Diet and exercise. Feeding your body a nutritious, healthful diet will support any healing process while exercising within your limitations and abilities (consult your physician!) will likely contribute to your overall improvement and enhance your mood. Physical therapy may also be an important adjunct to your healing regimen.
- Complimentary therapies. There is an increasing body of research showing that relaxation techniques, yoga, tai chi, meditation, homeopathic and naturopathic remedies, acupuncture, massage, and other alternative approaches to wellness can have a significant impact on pain management and enhancement of overall well-being. These can be used in conjunction with traditional allopathic treatments. Just be sure your primary care provider knows what you’re doing and is aware of any supplements you are taking (to ensure they will not conflict with your prescription medications).