Pain management at middle age and a true understanding of it is imperative for maintaining the goal of optimal health. We believe a comprehensive management approach is necessary from the onset of any pain condition. That way a patient is set up in a much more adequate position to deal with common sequelae such as depression, isolation, and physical disability.
At Jax Spine & Pain Centers we will examine the role of age as it relates to social and physiological development, cognitive processing, and coping skills of middle aged patients.
How does age influence the perception of the pain experience?
Pain in Older Adults
The assessment and treatment of recurrent pain in older adults (> 65 years of age) present special challenges for health care providers. One of the things that has become imperative for us to note – The importance of not generalizing “all” middle-age adults as being the same group due to similar ages. Genetics, etc. play a big role and we all age differently. There has been considerable variation across the older pain patient population. Each older patient presents unique coping skills, as a result, history, and intellectual skills need to be taken into consideration through the evaluation process and treatment for recurrent pain.
Growing Numbers in Pain & Middle Age
Research studies focusing on the older adult has grown considerably over the past 2 decades. This growth can be explained, in part, by the growing numbers of adults over 65 years of age. This demographic currently makes up approximately 10% of the total US population. According to the US Census Bureau, older adults are the fastest growing segment of the population. An average of 10,000 individuals turn 65 years of age each and every day. By 2030, older adults will represent 20% of the total population, or 72 million people, according to published statistics.
Longer lifespans also contribute to more chronic conditions. According to the Centers for Disease Control and Prevention, over two-thirds of older Americans suffer from multiple chronic conditions. Treatment for these conditions comprise 66% of the total health care budget.
In addition, estimates show that 60% to 75% of people over 65 years of age report having persistent pain. These same studies suggest that the prevalence of pain increases with age. And, women are more likely than men to report persistent pain.
Pain’s Impact on Older Adults
Chronic pain in the older population has a widespread impact on a variety of problems. These issues can include: activity restrictions, sleep issues, and mood.
Activity & Exercise
Limiting activity due to pain is a natural instinctual response, but in the case of persistent pain, it becomes a counterproductive strategy. It can actually lead to more pain. It’s often challenging to find activities older patients feel comfortable performing. Usually, the largest hurdle to overcome is the fear of falling. In addition, as older patients reduce their activity level, they will gain weight, which further compromises their agility level. Weight gain will place more stress on the knees, hips, and back, and often can result in more pain.
Pain & Sleep
Pain and sleep are often intertwined, but older patients present additional challenges. Older patients with persistent pain are twice as likely to report sleep problems. Those include a delay in sleep onset and excessive time in bed. Recent studies show, 42% of middle-aged and older patients with persistent pain experience chronic sleep deprivation. That sleep deprivation contributes to subsequent daytime fatigue and more inactivity.
In addition, older adults produce less melatonin, which influences the regulation of sleep cycles. Sleep medicine specialists generally believe that lower melatonin levels in older adults is a cause of reduced sleep in adults over 70 years of age.
A majority of patients with chronic pain are at risk for depression. The incidence of severe depression in older adults with persistent pain ranges from 19% to 28%. Although this association appears significant, not all older pain patients are depressed. Reports suggest that 75% of older adults in treatment in a multidisciplinary pain clinic report reasonable levels of pain control. These same patients subsequently report low levels of depression.
Physical Changes Shift Perception of Pain
Physical changes in older adults can influence the perception of pain. Recent research findings confirm that aging is associated with changes in the structure, function, and chemistry of the nervous system. The nervous system directly impacts the perception of pain. One example of change points out that the density of unmyelinated fibers in the peripheral nervous system decreases with age. This reduction in density will result in a slowing of nerve conduction.
The Role of Medicine
As we age, we also rely more on medicine—both prescription medications and over the counter (OTC) formulations and supplements—to maintain a quality of life. Recent research indicates that older adults take between 5 to 8 medicines daily, with 12% to 39% taking more than 9 different medications daily. If this trend continues, the number of older patients taking multiple medications will grow as the baby boomers age.
The use of OTC preparations also has escalated in the older population. Adults older than 65 years of age represent about 12% of the population but use 40% of all OTC preparations. This trend in self-medicating can be potentially problematic for older adults coping with chronic pain. Adverse drug interactions with OTC medications (ie, acetaminophen, ibuprofen, naproxen) among the older population are on the rise. Some estimates show 20%.
Physical Changes Affect Absorption
As we physically age, our ability to process medicines also changes. According to medical professionals the association of aging goes hand-in-hand with reduction in drug absorption. This is due to reduced gastrointestinal motility and blood flow. In addition, there are changes in muscle mass and an increase in body fat, poorer drug metabolism due to decreases in hepatic blood flow and liver mass, and reduced excretion due to declines in renal function. There also is evidence to suggest that molecular changes that occur with aging may be associated with receptor sensitivity to certain drug classes.
Behavioral Therapy in Older Adults
Behavioral therapy techniques are appropriate for older adults, provided they are not confused or that their memory is not compromised.
An additional factor to consider with older adults is a propensity to worry, which results in a higher level of psycho-physiologic arousal. If your patient is cold in the extremities, with possible color changes, temperature biofeedback may be indicated.
The influence of memory loss or dementia is an important consideration when treating older adults who live with persistent pain. Studies suggest 30% to 50% of older adults diagnosed with dementia experience persistent pain. When you combine dementia and pain, a number of behaviors can occur, including aggression, agitation, and confusion. In addition, a popular misconception that older adults with dementia feel and experience less pain may contribute to an underassessment and under-treatment of pain. The consensus of research suggests that older adults with dementia experience pain differently, but the perception of pain severity does not change.
In closing, there’s a lot to consider with pain management and middle age. At Jax Spine & Pain Centers, our Providers are committed to finding the best treatment plan right for you. Call 904.223.3321 today to set up an appointment.