Helping Seniors With Chronic Pain

According to the National Institutes of Health (NIH), research has shown that 50 percent of older adults who live on their own suffer from chronic pain. This is even higher for elderly in care facilities – it’s estimated at 75-85 percent.

Chronic pain can be debilitating when left untreated. Over time, it can prevent seniors from moving, leaving their home, sleeping or eating. This leads to depression, social isolation and anxiety. Studies have found that individuals with chronic pain are much more likely to develop additional physical or psychological problems due to their pain issues.

As a caregiver, it’s important to understand the causes of chronic pain and the types of behaviors that could signal discomfort. In some cases, seniors don’t report their pain because they assume it’s a natural part of aging or they fear it will lead to expensive treatment. For older adults with cognitive challenges, they may be unable to communicate exactly what’s happening.

Chronic pain doesn’t have to be an accepted part of growing older. With loving attention and care, you can help your senior have a better quality of life.

What Diseases May Cause Chronic Pain in Seniors?

Chronic pain in older adults can be caused by numerous factors. This is not an exhaustive list but touches on common issues. Persistent pain may be linked to an ongoing condition such as arthritis, diabetes, cancer, shingles, or fibromyalgia.

Arthritis is a musculoskeletal disease causing joint pain, inflammation and stiffness. There are two types. Osteoarthritis is the progressive wearing down of joint cartilage. Seniors suffering from osteoarthritis often have morning stiffness and sharp or dull joint pain in the fingers, knees, hips and spine. Rheumatoid arthritis is an autoimmune disease, which means the body is attacking itself. It’s characterized by sharp pain, swelling and deformity in the joints of fingers, feet and wrists. Elderly people with rheumatoid arthritis often have extended morning stiffness and warm, tender and swollen joints.

Diabetes can lead to a variety of complications including leg pain and cramps due to nerve damage called diabetic neuropathy. Common symptoms are pain, burning, tingling, and numbness. Catching nerve damage early is important, particularly because it can prevent lower leg amputations. Seniors with diabetes should report even mild discomfort to the doctor.

Cancer can cause pain in numerous ways. As tumors grow, they may put stress on bones, nerves, and organs around them and release chemicals that irritate the tumor area. Cancer-related tests, treatments, and surgery can also cause aches and discomfort. Seniors may feel pain like normal headaches and tight muscles.

Shingles is a nerve disease that can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters. Usually, it develops on one side of the body or face and in a small area. The most common place for shingles is a band that goes around one side of your waistline. The symptoms of shingles can range from mild to intense pain.

Fibromyalgia is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Although this disease is not completely understood, researchers theorize that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. Over time, these persistent symptoms can take a serious toll on overall quality of life.

Recognizing Chronic Pain in Seniors

Before any senior can explore their pain options, they will need help bringing their issue to light. Many seniors are unable or ashamed to admit they have chronic pain. In these situations, it’s up to their loved ones or caregivers to step in and help get to the bottom of the issue. For seniors who are unable to communicate their issues or feelings with pain, they may need their caregiver to look for signs.

Here are some of the signs and symptoms that caregivers should look for:

• Teary eyes or crying
• Insomnia or an inability to sleep
• Thrashing or writhing in pain while trying to sleep
• Severely decreased activity levels
• Wincing while moving
• Knitted eyebrows especially while doing certain activities
• Wrinkled foreheads
• Grimacing
• Moaning when being moved
• Being overly sensitive to even light touch
• Clenching fists
• Stiffening the upper or lower body while moving or holding one area of the body rigidly while moving
• Decreased appetite
• Being suspiciously quiet about questions regarding pain

Treating Chronic Pain in Seniors

According to the Journal of Practical Pain Management, “Treating pain in the elderly is complicated by the fact that 75% of people age 65 and older have two or more chronic conditions—such as heart disease, diabetes, chronic lung disease, or arthritis.” This creates a unique set of challenges to the healthcare team.

Traditional recommendations such exercise, stretching or balance tasks may not be feasible due to the physical limitations of the elderly. However, non-drug approaches should always be considered first. If your loved one is concerned about their mobility, physical therapy is a great option. They will have professional help in a safe environment. If your loved one is open to alternative approaches, you may also consider a chiropractor or acupuncture. However, it’s always important to obtain your physician’s opinion to make sure there are no risks involved.

Physicians prescribe medication more often to seniors when they have physical limitations, but this comes with its own set of risks. An elderly person, on average, takes nine or more medications per day, which increases the risk of adverse reactions between drugs. Additionally, older adults are already at higher risk of adverse drug events due to the natural changes in the body. For example, as we age, our gastrointestinal tract slows, which affects drug absorption rates.

The World Health Organization developed a cancer pain ladder for adults, which has been widely adopted for chronic pain from any source. They recommend, “If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain.” However, it should be noted that there is a great deal of controversy about the use of opioids because of their addiction qualities. Your senior’s healthcare team should be able to advise on the risks and benefits.

The National Institutes of Health offers this helpful list of questions to ask when prescribed medications to treat chronic pain.

• What is causing my pain? What can I do about it?
• What is the name of the pain medicine I will be taking?
• How long will it take for the medicine to work?
• What side effects should I expect?
• If I forget to take the pain medicine, what should I do?
• When should I take the pain medicine—on a regular schedule? Before, with, or after meals? At bedtime?
• Are there any dangers to taking this pain medicine I should know about?
• Will this pain medicine cause problems with any other prescription drugs or over-the-counter medicines I am taking?

When is Chronic Pain an Emergency?

While many seniors deal with varying levels of pain every day, when pain starts to get out of control, it is important that they see a doctor right away for assistance. A doctor should be called immediately if:

• Seniors exhibit a sudden inability to move or walk due to severe pain
• The pain becomes so bad seniors are unable to talk or function
• There is a new type of pain forming
• The pain the senior is experience is causing them to panic or causing distress
• The ongoing pain has become so bad that the senior talks of taking their own life or not wanting to live anymore
• Seniors are unable to sleep due to their pain
• There are adverse side effects to the senior's pain medication
• Seniors are having difficulty coping with their pain or the situations their pain has put them in

Situations such as this require immediate attention and are beyond the scope of normal, daily chronic pain.

How Loved Ones Can Help

We’ve talked a lot about monitoring your senior’s behavior and helping them choose appropriate treatment options, but caregivers can also do a great service to their loved one by helping them take their mind off their chronic pain. This is important for both seniors receiving in home care and those who are living in assisted living or nursing home communities. For many seniors, isolation can make their chronic pain worse. Feeling trapped or alone with pain can magnify its effects. Caregivers can step in with activities, short walks, outings or just conversation to take their mind off the discomfort. Make sure they know that you care, and that you’ll work together to find a treatment for their pain.