Just because you are a senior does not mean you need to be in pain
Dr. Robert Odell is an anesthesiologist practicing in Knoxville, TN. Dr. Odell ensures the safety of patients who are about to undergo surgery. Anestesiologists specialize in general anesthesia, which will (put the patient to sleep), sedation, which will calm the patient or make him or her unaware of the situation, and... more
Pain is Not Synonymous with Aging
Robert Odell, Jr, MD, PhD
Neuropathy & Pain Centers of Las Vegas
I listen to complaints of my patients about their pain for a living; I am a pain doctor! However, I also hear a lot of people complain that they have pain because they are old. It is true that many aging processes, such as joint osteoarthritis and degenerative disc disease of the spine cause painful conditions in all Americans. Some of these processes cannot be controlled, such as hereditary; some of these conditions are lifestyle-related and some date back to remote life traumas, both major and minor, which have accelerated osteoarthritis and disc degeneration.
Aging does not always include living in pain. And I am not talking about taking narcotics which can be risky and habit-forming, especially in the elderly. What I am talking about is utilizing the many advances in medicine which permit the healing or attenuation of many of these conditions. Americans are walking around with pain which limits their lifestyle, enjoyment of their retirement and a golden, interaction with their family, and the maintenance of optimal health. My goal is not only to improve your quality of life with sound education (the word “doctor” means "to teach") but also to get you into optimal physical condition through exercise and good lifestyle choice to prolong a healthy life.
Before I talk about specific pain conditions, I want to briefly outline some of the advances in medicine that provide doctors with more tools in their toolbox. Energy medicine - the use of electricity, ultrasound, magnetic therapy, and mechanical energy - are now providing for patients virtually risk-free opportunities for healing. Electricity has been used for healing since 3000 B.C. When Becker showed in 1982 that he could regenerate the hind limb of a frog, any reasonable arguments against the role of electricity in physiology were removed. Wound healing is controlled by electrical fields. Drs. Wall and Melzack discovered in 1965 the gate control theory of pain; transcutaneous electronic nerve stimulation (TENS) has been widely used to temporarily diminish local pain. Now, far advanced electromedical cell-signaling devices exist which promote healing of nerves and muscles.[1]
Another exciting advance is in regenerative medicine utilizing platelet-rich plasma (PRP), autologous, and embryonic stem cells. Third-party payers had been slow to cover regenerative medicine procedures. However, recently even Medicare has begun covering some aspects of regenerative medicine; research is ongoing as attempts are made to ensure that these products are safe, effective, and provide some modicum of standardization.
Turning our attention to the common causes of pain in an older population and the more common body areas affected, most common complaints include low back pain, neck pain, knee pain, hip pain, and shoulder pain. Neuropathic pain[2] affects 8% of the population with a prevalence in older patients; distal symmetric neuropathy, one of the most common, is caused by diabetes, chemotherapy, Agent Orange, other toxins, or is idiopathic (no known cause). My clinic’s protocol can relieve neuropathic pain of all causes in over 80% of patients.
The causes of low back and neck pain are similar except that the prevalence of low back pain is much greater. In older Americans, the most common cause is osteoarthritis of the facets – the little joints in the back of the spine. This pain is worse in the morning and aggravated by extension and rotation. It can be successfully be treated by using radiofrequency ablation (RFA), and some of the newer needles provide treatments that last up to two years. In my experience, most neck pain is facet mediated One of the most rewarding procedures for me and my patients are treating cervical facet mediated pain. Another cause of spine pain is spinal stenosis; patients with lumbar stenosis often lean over to relieve their symptoms when walking.[3]
Previous treatment involved major surgery - laminectomies at multiple levels. Newer technology involves the simple outpatient procedure of placement through the skin of a device between two vertebrae to relieve both central canal and neuroforaminal stenosis.[4] Finally, discogenic pain can be treated by a variety of noninvasive and minimally invasive techniques including traditional epidural steroids. Cervical and lumbar vertebral axial decompression in the late 1990s got a bad rap when Medicare arbitrarily ruled against its coverage; however, this is of one the most effective techniques that I know of to treat discogenic pain, especially in seniors with degenerative disc disease. Minimally invasive discectomy techniques done by pain management physicians can treat specific discs.
Musculoskeletal pain of a less serious nature can be myofascial (caused by the muscles and soft connective tissue). This may easily be treated in the doctor's office utilizing energy techniques, trigger point injections, and chiropractic care.
Joint pain is one of the most debilitating conditions in our senior population. Knee pain especially is rampant, often caused by our epidemic of obesity. Most people do not realize that climbing stairs put a force on the knee joint which is five times body weight. The great news is that short of total joint replacements, there are at least four other very effective treatments for knee pain. These well-tolerated minimally invasive procedures usually only involve injections into the knee, done in the office.
My goal has been to convince you that even if you are old, you do not have to live in pain. Usually, something can be done about it without resorting to medications. Musculoskeletal, spine, and joint pain can be effectively and safely treated in the vast majority of cases.
If you have any questions please feel free to email me at bodell@nvneuropathy.com, or, better yet, visit your friendly chiropractor, orthopedic surgeon, or interventional pain physician.
[1] Comparing some of this equipment to TENS is like comparing an MRI to an x-ray.
[2] Neuropathic pain is defined as nerve dysfunction being the source of the pain; the nerve is no longer simply reporting pain.
[3] The shopping cart sign.
[4] Pinching of the spinal nerves that occurs as the nerves go between the vertebrae.
