Chronic pain is one of the major concerns worldwide. Chronic pain in the elderly can be a challenging situation for clinicians not just for the complexity of chronic pain itself but also for the comorbidities that can be present at this age range.
Several factors of aging (without the comorbidities) can interact with chronic pain pathophysiology making it more complex.These factors are related with muscle loss, bone fragility, immune adaptations, nerve functioning adaptations, fat percentage, cognitive impairment, sleep disorders, pharmacologic therapies, etc. And when aging is associated with other pathologies or non-optimal lifestyle, this interaction between the aging process and chronic pain is increased; worsening the quality of life of the person.
As one example of aging characteristics that can interact with pain mechanisms, we can highlight the sleep difficulties that this age group may experience and how important sleep is to target chronic pain mechanisms. For this topic, let me guide you to this blogpost of my colleague, Thomas Bilterys, who talked about how sleep is regulated (http://www.paininmotion.be/blog/detail/sleep-regulation-important-issue).
Another example is problems with weight control and fat percentage, leading to an increase of low-grade inflammation amplifying the disruptive mechanisms of chronic pain. For this topic, I recommend the blogposts of my colleague Anneleen Malfiet who talked about alimentation and weight management related to pain (http://www.paininmotion.be/blog/detail/obesity-hurts-should-we-consider-weight-management-within-pain-management; http://www.paininmotion.be/blog/detail/food-thought-should-we-consider-nutrition-chronic-pain-management).
If we keep breaking down the complexity of this interaction, the elderly population tends to have strong beliefs regarding pain functioning. As education is one of the selected techniques for a multifocal approach for chronic pain, it is important to tailor a proper education intervention to allow them to understand which is going to be the approach selected and why it is important to aim to all these factors of their lifestyle.
So now, the big question: How we deal with all these factors?
Well, through the interview we should be able to target which factors are going to be easier to start with in each case. Always collaborating with other professionals to approach all the factors with the most specialized way. Assuring a controlled drug use, proper protein intake, healthy diet and weight control, muscle gain, etc. It is important that the intervention adapts to the treatments that the person is already receiving without blocking them (i.e., pharmacology) and that the patient understands the WHY of each action.
We can conclude that, when we are helping an older adult with chronic pain, there are several things that we need to assess and target: weight control, physical activity, habits, alimentation, sleep, etc. All these factors plus comorbidities can make us feel overwhelmed as healthcare professionals, but this can also be seen in a way where no matter the action that you take,if it targets one of these factors, it is a good way to start to improve the process as all these factors relate to one another.
Good luck!
Pere Bacardit Pintó
Pere is working as physiotherapist at FISAL and Centre de Fisioterapia Núria Caballé in Barcelona, and as assistant professor at Tecnocampus Mataró.
2022 Pain in Motion
References and further reading:
Paladini A, Fusco M, Coaccioli S, Skaper SD, Varrassi G. Chronic Pain in the Elderly: The Case for New Therapeutic Strategies. Pain Physician. 2015 Sep-Oct;18(5):E863-76. https://pubmed.ncbi.nlm.nih.gov/26431140/
Lahav Y, Levy D, Ohry A, Zeilig G, Lahav M, Golander H, Guber AC, Uziel O, Defrin R. Chronic Pain and Premature Aging - The Moderating Role of Physical Exercise. J Pain. 2021 Feb;22(2):209-218. https://pubmed.ncbi.nlm.nih.gov/32798763/
Tinnirello A, Mazzoleni S, Santi C. Chronic Pain in the Elderly: Mechanisms and Distinctive Features. Biomolecules. 2021 Aug 23;11(8):1256. https://pubmed.ncbi.nlm.nih.gov/34439922/
Distefano G, Goodpaster BH. Effects of Exercise and Aging on Skeletal Muscle. Cold Spring Harb Perspect Med. 2018 Mar 1;8(3):a029785. https://pubmed.ncbi.nlm.nih.gov/28432116/
Santoro A, Bientinesi E, Monti D. Immunosenescence and inflammaging in the aging process: age-related diseases or longevity? Ageing Res Rev. 2021 Nov;71:101422. https://pubmed.ncbi.nlm.nih.gov/34391943/
Yaremchuk K. Sleep Disorders in the Elderly. Clin Geriatr Med. 2018 May;34(2):205-216. https://pubmed.ncbi.nlm.nih.gov/29661333/