5 Coping Mechanisms for Chronic Pain in Older Age Patients

It’s no doubt challenging to see someone you care about in pain. One of the disheartening things about getting old is the aches and pains that accompany old age. Chronic pain is one of the most common problems experienced by older adults. According to a study carried out by the National Institutes of Health (NIH), nearly 53% of seniors over the age of 65 experience chronic or persistent pain.⁽¹⁾ If persistent pain at old age is left untreated, or even undertreated for that matter, it can lead to a wide variety of adverse consequences. This can include reduced mobility, avoiding physical activity, higher risk of falls, anxiety and depression, sleep disorders, and a feeling of being isolated.

One of the most shocking things about pain in the elderly is that it is usually underreported. There are many reasons behind the underreporting and lack of treatment for chronic pain in older adults, including:

• Most older adults just assume that chronic pain is a normal part of the aging process.
• Illnesses tend to have an atypical presentation in older adults due to a lot of physiological changes because of aging.
• Many older adults fear having to undergo additional diagnostic tests and take medications, costing them more money.
• Those who experience this pain due to an underlying disease often fear that the pain could be a sign of further disease progression.

Here are some coping mechanisms for chronic pain in older patients to improve their quality of life.

1. Finding Out the Cause of Pain

   The first step to coping with pain is to find out the cause of the pain. It is important for older adults to understand that chronic pain is not a natural part of the aging process. This is why the first thing you should do is to seek help from a doctor to correctly evaluate the pain and level of discomfort caused by the pain. However, because of all the reasons older adults usually do not report or underreport their pain, it can be a complicated process to evaluate and assess pain.^{(2, 3, 4)}

   To help assess pain properly, there are many assessment scales that are simple to use, and even elderly patients won’t have any problem in explaining their pain level. For example, these assessment tools ask simple, and description questions like ‘describe your pain on a scale of zero to agonizing,’ or some of the tools can make use of numeric scales like ‘describe your pain on a scale of 0 to 5, with 0 being no pain and 5 being unbearable and persistent pain.

   It is important to keep in mind that many older patients might not be able to communicate about their pain properly because of emotional or cognitive impairment. This makes it especially important for the caregivers of older adults to be very observant, especially if there is a cognitive decline or another medical condition that might prevent them from accurately describing the level and nature of their pain.

   Some of the symptoms that your older age patient is experiencing chronic or heightened pain include:^{(5, 6)}

   • Changes in their functional status
   • Changes in their body posture
   • Increased agitation
   • Changes in their gait
   • Social isolation
   • Refusal to engage in physical activity or lethargy
   • Depression
   • Moaning or groaning when standing up or sitting down.
   • Consistent grimacing expressions, or making clenched fists.
   • Awkward and slow movements.
   • Loss of appetite.
   • Mood changes.
   • Having trouble grasping or holding things.

   If you notice any such symptoms, it might be time to assess their pain.

2. Help Them Keep Up With Their Treatments

   Getting an older adult the care and treatment they need is extremely important to help manage their pain while also maintaining their independence. Treatment of chronic pain involves working together with many different specialists, including a physician, physician assistant, pharmacist, nurse practitioner, and many others who specialize in chronic pain management.

   If you are the primary caregiver, it is important to ensure that your older age patient is going to all their doctor’s appointments and physical therapy sessions. It is important to remind them to take their medications and also keep an eye out for any type of side effects. You also have to share their medical information, including their symptoms, with their healthcare team. Keeping others in their caregiving or social circles, such as friends and family, aware of their health and treatment regimen can also help take some of the stress off of just one caregiver.⁽⁷⁾

3. Ensuring That The Medication Is Taken Correctly And Carefully

   If an older adult is suffering from inflammation-based chronic pain, they may benefit from using anti-inflammatory drugs. While opioid painkillers are a popular option, but these medications are known to have many side effects and risks, and doctors usually avoid prescribing them to older age patients.^{(8, 9)}

   A widely accepted alternative to these medications that provides a good amount of relief from pain is palmitoylethanolamide (PEA), which is a drug that is known to be quite effective in treating chronic pain, especially inflammation-based chronic pain.^{(10, 11)} This medication option is particularly appealing because it does not have any risk of addiction that is typically associated with opioids, and it has good pain-relieving effects as well. It is important to keep in mind that any type of medicine that is being taken for chronic pain needs to be taken carefully and exactly as prescribed by the doctor to avoid accidental overdose or side effects. In older adults, caregivers need to make sure of this.

   For any older adult, living with an underlying health condition, especially if it causes chronic pain, can make life very challenging. However, it is possible for them to have a better quality of life if they take their medications properly and carefully.

4. Explore Alternative Therapies

   There are many alternative treatments that can be effective for older adults who are dealing with chronic pain, especially if they want to avoid taking or depending on the medication. Over the years, the field of pain management has witnessed a lot of advancements and research, and clinical research has acknowledged that there are biological, sociological, and psychological components associated with chronic pain.⁽¹²⁾

   According to estimates by the National Institute on Aging, 41 percent of older adults regularly use alternative and complementary medicine, including herbal supplements, vitamins, acupuncture, meditation, massage and chiropractic manipulation.⁽¹³⁾ However, it is important that you never try out any type of complementary and alternative treatment without consulting your doctor first. Remember that many elderly patients may be too weak or fragile to undergo the traditional techniques involved in manipulation and massage therapy, and many poses of yoga also might be strenuous and challenging for them. This is why it is best to first ask a doctor before beginning any of these therapies.

   Some alternative therapies for pain management in older age patients include:

   • Acupuncture: This is a very popular alternative treatment for chronic pain. Many studies have shown that acupuncture can successfully relieve many types of chronic pain, including knee pain, neck pain, chronic lower back pain, osteoarthritis, and even migraine headaches.⁽¹⁴⁾ Acupuncture has also been found to reduce the severity of pain, making it a reasonable option for those who have chronic pain. In fact, many older adults seek acupuncture therapy on a regular basis not only to get relief from their pain but also because it helps them get a feeling of general well-being.⁽¹⁵⁾
   • Chiropractic Care: This popular alternative therapy for managing chronic pain is known as the fourth most commonly used complementary and alternative treatment method in the US. Chiropractic treatment has been found to be far more effective in relieving chronic pain as compared to hospital outpatient treatment. It also helps improve the flexibility of the muscles. However, one small side effect of this form of treatment involves experiencing some temporary discomfort in the area that was treated, tiredness, and headache. Serious complications are rare.^{(16, 17)}
   • Cognitive Behavioral Therapy, Mindfulness, and Meditation: These alternative treatments focus on dealing with the psychological part of the pain. Extensive evidence confirms the effectiveness of cognitive behavioral therapy in the treatment of both chronic and acute pain. However, this type of therapy requires a patient to follow a committed route, which could be an issue if an older age patient has transportation problems or mobility issues.^{(18, 19)} Mindfulness, on the other hand, increases your awareness of the present moment, helping manage the pain of many kinds. Mindfulness techniques make use of breathing methods, guided visual imagery, and others to help relax the body and the mind, having an effect on relieving the pain.^{(20, 21)} Mindfulness is also a form of meditation. Meditation, meanwhile, helps retrain the brain pathways to deal with pain. Over a period of time, meditation can help change the brain structure itself to allow you to deal better with your pain.^{(22, 23)}

5. Manage Stress Levels

   Stress is a significant factor that is associated with chronic pain in older age patients. Stress not only increases pain but it can also make it more challenging to manage any chronic health conditions. Here are some tips for older adults who are living with chronic pain to manage their stress levels:

   • Seek support from family and friends.
   • Avoid staying alone and withdrawing into yourself.
   • Explore relaxing activities that help you feel happy.
   • Try meditation, yoga, Pilates, or Tai Chi.
   • Consider seeking talk therapy or psychotherapy. It often helps to share your feelings with a stranger.
   • Maintain a journal and write down your personal feelings that you associate with chronic pain.

It is not easy to deal with chronic pain, especially in older age. Even dealing with an older adult who is living in chronic pain can be a challenge. These coping mechanisms can help elderly citizens live safely and comfortably while managing their pain. Staying physically active and keeping in touch with your friends and family can go a long way in making your life better and also help you focus on other things apart from the pain.

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