Aging and Arthritis Pain

Aging and Arthritis Pain: Should Treatment Plans Change as We Age?

Pain and aging—it’s an unfortunate fact of life. As we increase in age, so does our risk for painful health conditions. Research also suggests the experience of pain changes as we age; the treatments for it must often change as well.

More Painful Problems

“As we get older we are more likely to experience pain because of the kinds of health problems that go with getting older,” says Patricia A. Parmelee, PhD, director of the Alabama Research Institute on Aging at the University of Alabama in Tuscaloosa. “There are a number of disorders linked with the aging body that are painful,” she says. Of these, one of the most common is osteoarthritis (OA).

The likelihood of developing arthritis increases with age. The CDC reports that 7% of people between the ages of 18 and 44 say they have doctor-diagnosed arthritis. Among people 65 and older, that number is 50%.

How Pain Is Perceived

When older people have pain, research suggests the experience may be different from that of younger people.

In 2003 researchers at the National Ageing Research Institute in Australia published an analysis of more than 50 studies that examined age differences in sensitivity to induced pain. They found definite evidence of an increase in pain threshold with advancing age.

Researchers don’t fully understand why pain perception to be less acute in older people, but suspect a number of factors are likely involved.

Just as senses such as vision, hearing and taste may be less keen in older people, the sensation of pain may be blunted as well, says Parmelee. Most studies examining pain differences are performed using carefully measured stimuli in a laboratory. But pain induced in a laboratory doesn’t necessarily represent “the real world pain experience,” she says. “There are very complicated physiological differences in the way older and younger people experience pain, but there are also strong differences in how likely we are to react emotionally.”

There is some evidence that younger people have stronger emotional reactions to chronic pain. Beth Darnall, PhD, a pain psychologist at Stanford University School of Medicine in California, believes one reason for that is younger people lack the life experience and perspective to cope with a painful condition. “It might be the worst thing that has ever happened to them,” she says. “They may not have lived long enough to develop the skills to cope with a challenge like that.”

Parmelee believes pain may cause more emotional distress in younger people because it is unexpected. “Painful conditions – particularly OA – are intrinsically linked with our expectations of how we are going to age,” she says. “To some extent that normative experience may make pain a little easier for older people to deal with emotionally.”

On the other hand, older people living with several chronic or painful conditions have their pain and stress multiplied. They may not have the social support they need to help them cope with their pain and daily activities. Stress and lack of social support can intensify the pain experience.

Treating Pain

Whether pain is expected or not, older people should not accept it, says Parmelee. “There are many good things people can do to cope with arthritis pain.” She recommends an overall approach to physical and emotional wellness that includes physical activity, a healthful diet, adequate sleep and enjoyable activities.

For most people, medication is also an important part of managing pain. In many cases, medication to treat the underlying cause of pain – for example, treating inflammation in arthritis – is helpful for relieving pain. Your doctor may also prescribe medicine specifically for pain, but your age and other health problems will need to be considered.

In its 2009 treatment guidelines, the American Geriatric Society recommends acetaminophen as the initial and ongoing drug treatment for persistent pain, particularly musculoskeletal pain. It warns, however, against using acetaminophen if you have liver disease or a history of alcohol abuse.

While nonsteroidal anti-inflammatory drugs (NSAIDs) are a mainstay of treatment for pain in younger people, the society advises “extreme caution” in older patients. People with chronic kidney disease, heart failure or a history of stomach ulcers should not take NSAIDs. Furthermore, taking NSAIDs along with low-dose aspirin to protect against heart attacks may increase the risk of side effects.

For moderate to severe pain, the American Geriatric Society says opioids and other drugs (including antidepressants and muscle relaxants) should be considered, but caution is necessary. Age-related changes in muscle mass, body water content, and kidney and liver function can affect your body’s ability to use these drugs. For that reason, your doctor will monitor you closely while adjusting your medicine dose.

It’s also important to be aware that opioids can blunt the senses and increase the risk of falls, says Darnell. “These are a few examples why we really need to target treatment to the individual.”

Breaking the Arthritis Pain Chain

When you’re in pain, it’s hard to believe there’s a way to live without daily discomfort, especially if you’ve been living with chronic pain for years. But knowing what causes your pain and how to manage it can empower you to break the cycle of pain and live life to the fullest. That’s why we created “Breaking the Arthritis Pain Chain,” an online toolkit that will help you understand your pain, give you practical tips for creating a personalized pain management plan, and more! Check out the toolkit at http://www.arthritis.org/toolkits/arthritis-pain/.

Mary Anne Dunkin for the Arthritis Foundation

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