|
E-mail this page to a friend!
Baby Boomers
Being a Baby Boomer is a Pain, Researcher Says
Welcome to 'Golden Years' of chronic pain -
seniors live with it
by Nancy Chan
| |
 |
| |
Pamela
Palmer, MD |
A great deal of attention is being paid this year
to Americans who are turning 60, the first of the baby boomers born
between 1946 and 1964. Baby boomers already appear to be setting
themselves apart from their parents and grandparents with more active
and productive lifestyles in what formerly were termed “the golden
years.”
Ironically, though, while people are living longer,
thanks to the advances made by modern health care, boomers are also now
finding truth in the axiom “The mind is willing, but the body is weak.”
One of the most common reasons is chronic pain, where one out of every
five individuals takes a pill daily to relieve acute aches and soreness.
Pamela Palmer, MD, PhD, is the director of
University of California at San Francisco (UCSF) PainCARE — Center for
Advanced Research and Education, which was launched in 2004 to build
upon the UCSF Pain Management Center’s nearly 20 years of success in
caring for patients with the worst of the worst types of pain.
Palmer believes that all physicians and nurses,
particularly those on the front lines of patient care, need to be
skilled at assessing pain and determining an appropriate course of
action — whether by treating the patient’s pain if it’s a condition that
is manageable at the local clinic setting, or by appropriately referring
the patient to a pain specialist when a more advanced level of care is
required.
Q: Pain is one of the “common denominators” of
life. Back pain, arthritis, headaches — if we aren’t in pain ourselves,
we all know someone who is. In fact, pain is the number one presenting
symptom for most medical conditions. How would you describe pain?
| |
 |
| |
Do Seniors Just Learn to
Accept Pain?
Pain is the number one complaint of older
Americans, and one in five older Americans takes a painkiller
regularly.
The above chart from Americans Living With
Pain Survey, (May 2004, American Chronic Pain Association)
however, shows the emotional stress on senior citizens is much,
much less than it is on Baby Boomers and other younger adults.
The Pain in America: A Research Report done
in 2000 found that four out of five Americans believe that pain
is a part of getting older, and approximately sixty four percent
would see a doctor only if their pain became unbearable. Sixty
percent of the respondents said that pain was just something
that you have to live with. A surprising twenty eight percent
indicated that they felt that there was no solution for their
pain. – American Academy of Pain Management.
Maybe older Americans accept chronic pain
better than young people because it is a case of "mind over
matter." A study released last year used brain imaging to find
that positive thinking shapes the sensory experience of pain.
The decreasing expectation of pain can
reduce both the pain-related brain activity and perception of
pain intensity. The study was funded by the National Institute
of Neurological Disorders and Stroke (NINDS), a component of the
National Institutes of Health (NIH).
When expecting pain, we first form an
active mental picture of the event that is about to happen.
This picture is composed by incorporating past experiences with
the current situation and what we believe will happen.
Secondly, brain regions that are involved with the mental
picture interact with the brain areas responsible for processing
pain. As a result, the brain regions supporting the experience
of pain are modulated by these predetermined expectations. |
A: For some patients, pain is
straightforward. They have arthritis or other conditions that respond
well to prescription anti-inflammatories or a combination of medication
and physical therapy, and are back to being active relatively quickly
after seeing their physicians.
But when pain results from a traumatic event like a
car accident, how a patient’s body responds to that incident can be more
important than the actual trauma. One person may be treated for the
acute pain and never have a problem again. Another may develop chronic
pain because of neurological processing that results in the central
nervous system developing a “memory” of pain. This can also be true for
seemingly minor injuries, such as an ankle injury, where a patient’s
simple sprain turns into the much more difficult condition known as
complex regional pain syndrome (also known as reflex sympathetic
dystrophy).
Pain is complex and is a combination of anatomic
and behavioral processes. When defining pain, one can think of
nociception — the perception of pain — plus the level of suffering. The
nervous system sends painful signals to the brain, and the patient’s
brain interprets those signals based on his or her life experience, as
well as the actual medical condition itself. It’s not just the
physiological cause of the pain, but the degree of suffering and the
events in the patient’s life experience that contribute to that
patient’s sense of pain that we need to evaluate.
Q: How do you approach treatment of pain?
A: At the Pain Management Center, we see
numerous types of pain, including back pain, cancer pain, post-herpetic
neuralgia (pain from shingles), complex regional pain syndrome,
myofascial pain, neuropathic pain, post-injury or surgical pain, and
rheumatologic pain, among others. We perform diagnostic procedures,
nerve blocks and other types of injections, implantable therapies and
neuroablative procedures, and may also prescribe oral or other
medications, or refer patients to our physical therapist, psychologist
or biofeedback specialist, if needed.
| |
The economic
impact that chronic and acute pain has on society is enormous.
It is reported that more than half of patients reporting chronic
pain are older than 55. This burden is expected to grow in
future years as the numbers of baby boomers age. |
We take a multidisciplinary approach by treating
the whole person. We look at root physiological causes and also look at
potential psychological factors because pain can lead to depression,
anxiety and family hardship. And these same factors can also cause or
worsen pain, or even lengthen the time course of the pain.
So, it’s really important to try to determine what
pain means to each patient — and in this regard, patience is key. It can
take up to six months in chronic pain conditions to fully evaluate what
anatomical and behavioral factors play a role in any given patient.
Q: What do you think of the phenomenon of the
wave of baby boomers turning 60?
A: It’s more than a little scary when you
stop to think about it. By 2011, 20 percent of Americans will be over
the age of 65. Compare that to the year 1900, when only 4 percent of
Americans were over 65. That population has grown to a bigger percentage
because we can now treat cancer, diabetes and many other diseases
better. But from the musculoskeletal standpoint, we’re also now seeing a
larger number of elderly patients with degenerative spine and joint
disease. In some cases, it’s due to genetic predisposition for people
who have spinal disease in their 30s and 40s. In others, we’re simply
outliving our spines and joints — in essence, it’s a natural
progression.
Fortunately, although we’re not yet able to reverse
mechanical degeneration, orthopedic procedures such as joint replacement
have advanced to such a degree that, with adequate pain management,
patients are able to be active and vital well into their 80s and beyond.
But what concerns many of the leading pain
management experts worldwide is the sheer volume of patients with pain
who will be flooding the health care system in the next 10 to 20 years.
Many major medical and nursing schools still don’t provide intensive
pain management training for their students — particularly those who
will become the first point of contact for those patients who say, “I
have pain here.” And there simply won’t be enough pain management
specialists to meet this demand if frontline providers refer patients
who could be treated in local clinic settings.
We’re not ready for the wave, which means we have a
potential health care crisis right in front of us.
Q: What are some other pain issues that you see
with age?
A: We have published studies showing that
there is a difference in tolerance between age groups when using opioids,
such as morphine, to treat pain. When taking daily opioids for
longstanding chronic pain conditions, older people actually report
greater pain relief than younger patients, and yet require lower doses.
Unfortunately, because the stigma of addiction remains, older people are
still often reluctant to take opioids when they are the population most
likely to benefit from their use in the chronic setting.
Educating patients and health care providers about
these tolerance differences is one of the things we’re doing through
UCSF PainCARE and the Pain Management Center. We have a patient
education group that meets monthly, and we also provide training
programs for health care professionals, including our Challenges of
Managing Pain series and our online pain management certificate program.
Q: You’re training doctors online?
A: Yes, and nurses, physical therapists,
psychologists and other health care providers, as well, through the UCSF
Postgraduate Certificate in Pain Management/Online Program. We’re
collaborating with the University of Sydney and University of Edinburgh
to offer the first truly global system of postgraduate pain management
education for all health care practitioners who are involved in
assessing, diagnosing or treating patients with pain who realize they
need more advanced training to improve their patient care.
The program is delivered entirely online, so it’s
more convenient for health care providers — who are finding it difficult
to leave their busy practices to travel to live conferences — and it’s
more intensive than these traditional live programs. It’s based on the
Core Curriculum for Professional Education in Pain developed by the
International Association for the Study of Pain, and it takes three
consecutive academic quarters to complete. So, participants really
develop a solid foundation in the assessment and management of the
various types of pain they’ll be seeing when the wave of baby boomers
hits their front doors.
Q: How do you foresee the future for baby
boomers?
A: When we dream of retirement, we think
we’ll spend our days doing exactly as we please — whether it’s gardening
or golfing. But as it stands now, growing old is not for the faint of
heart. Too many people over the age of 60 have pain and related
depression or anxiety that robs them of their quality of life.
Routine things, such as standing and sitting, may
prevent them from playing with their grandchildren or even going out to
the movies. Even my favorite sport, golf, can worsen low back problems
by causing repetitive stress injuries just when retirees finally have
enough time to truly enjoy the game. So, at the Pain Management Center,
we often ask our older patients, “What is the one thing you can’t do
anymore, but still wish you could?” We listen, and then we try to help
them regain as much ability in that area as we can.
Q: Any last thoughts?
A: I once heard a prominent physician here
at UCSF say, “Pain doesn’t kill anyone.” Many of us, when we hear a
statement like that, are concerned — and rightly so — because there is
so much more to delivering quality health care than just keeping a
patient alive. On the flip side, though, I’ve heard other health care
providers say that no one should ever be in pain. And I’m equally
concerned because that statement can lead to unrealistic expectations
for patients and their families, and can actually make it harder to help
patients with pain.
It’s important to help patients understand that
pain is a fact of life and that pain management is not a cure. Pain
management is just that — managing the patient’s pain in a way that
reduces suffering to the maximum extent possible, offers hope and
ultimately leads to a better quality of life. These are worthy goals for
all of us who see, or will be seeing, patients with pain.
More About Chronic Pain
The Two Faces of Pain: Acute and Chronic
What is pain? The International Association for the
Study of Pain defines it as: An unpleasant sensory and emotional
experience associated with actual or potential tissue damage or
described in terms of such damage.
It is useful to distinguish between two basic types
of pain, acute and chronic, and they differ greatly.
● Acute pain, for the most part, results from
disease, inflammation, or injury to tissues. This type of pain generally
comes on suddenly, for example, after trauma or surgery, and may be
accompanied by anxiety or emotional distress. The cause of acute pain
can usually be diagnosed and treated, and the pain is self-limiting,
that is, it is confined to a given period of time and severity. In some
rare instances, it can become chronic.
● Chronic pain is widely believed to represent
disease itself. It can be made much worse by environmental and
psychological factors. Chronic pain persists over a longer period of
time than acute pain and is resistant to most medical treatments. It
can—and often does—cause severe problems for patients.
Pain is a silent epidemic in the United States. An
estimated 50 million Americans live with chronic pain caused by disease,
disorder or accident. An additional 25 million people suffer acute pain
resulting from surgery or accident. Approximately two thirds of these
individuals in pain have been living with this pain for more than five
years.
The most common types of pain include arthritis,
lower back, bone/joint pain, muscle pain and fibromyalgia. The loss of
productivity and daily activity due to pain is substantial. In a study
done in 2000 it was reported that 36 million Americans missed work in
the previous year due to pain and that 83 million indicated that pain
affected their participation in various activities.
Links to more information on chronic pain:
American Chronic Pain Association
American Pain Society -
American Pain Foundation -
National Institutes of Health Pain Consortium - Has information on
major sources of pain.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
