Getting old: is it painful?

When I first became an osteopath, I remember lots of people saying “Is it mostly old people you see?”.  Funnily enough, it wasn’t.  I didn’t see that many elderly people, certainly not a disproportionately large number.  (If anything it was disproportionately fewer).  But I know why people said it.  It seems to be a prevalent belief that as you age, you ache.

I still don’t attract many elderly patients, partly because I live in Brighton which is unusually young, but I had assumed it was for other reasons too:  because elderly people were more stoical; they had conditions like osteoarthritis which were more likely to need ongoing, regular (i.e. expensive) treatment – harder if you’re on a fixed income; maybe because they were dosed up to the eyeballs with medications which numbed their bodies anyway, and because they came from a generation in which body treatments weren’t on the radar.  In the UK massage was until recently a euphemism advertised on cards in phone boxes. Maybe they didn’t want to get undressed in front of a stranger.  But I have revised my opinion after reading an excellent paper published in The Journal of Family Practice.  Maybe it’s just because they suffer less pain, in particular, less back pain.

Read the full paper here – it’s short and easy reading

But read the even shorter version here – it’s basically a MYTHBUSTING piece

  •  PAIN IS NOT A NATURAL PART OF GETTING OLDER

Thank goodness for that!  We might have to put up with fading eyesight and Loose Women being the highlight of the day, but we are not condemned to inevitable physical pain.  Yes of course some older people do have pain, but there hasn’t been a direct correlation found with age, and the prevalence of chronic pain seems to gradually decline from age 65 onwards. There is actually a lower prevalence of low back, neck, and face pain among older adults compared with their younger counterparts, and some studies have found lower rates of headache and abdominal pain.  I wonder why?

  • PAIN DOES NOT INTENSIFY OVER TIME

More good news.  Pain does not inevitably worsen over time.  Most studies find the prognosis for musculoskeletal pain does not worsen with age.  Even with degenerative diseases there is no clear correlation of pain worsening with narrowing joint spaces.

  • STOICISM DOES NOT HELP

Older patients are more likely to grin and bear it, maybe a hangover from the days when there was less help on offer so you had no other option.  They are also less likely to label a sensation as painful. Studies give mixed results to the question of whether nociception increases or decreases in old age.  And there is growing evidence in pain science that paying too much attention to pain, or the wrong sort of attention makes it worse.  But this paper shows that  living with pain causes depression and insomnia whether you admit the pain or not.  You’re better off at least trying to get a bit of help with it.  Try to let older people know they don’t have to keep a stiff upper lip.

  • PRESCRIPTION PAINKILLERS ARE MOSTLY NOT ADDICTIVE

People are a bit scared of taking prescription drugs, especially opioids, and especially older people.  The phrase “addicted to prescription painkillers” is regularly on the news.  Family and friends, and even 16% of doctors, share this fear.  However the risk  of drug misuse is not that high (3% or so).  It decreases with age.  Most elderly patients only need one or two prescriptions, and long term use is relatively uncommon.  It’s OK to take a few drugs if you’re in pain.

So spread the word:

pain is not a natural part of aging and often improves or remains stable over time,

stoicism does not lead to acclimation,

and pain medications are not highly addictive in older adults

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