Plagued by pain

Plagued by pain

Creaky knees, frozen shoulders, a radiating pain in the leg - such are the unwelcome 'trophies' of one's golden years.

Chronic pain hits one in five people aged 65 and above, making them the biggest group of people suffering from pain.

This statistic comes from the Pain Association of Singapore. Its local study was published in the Annals Of The Academy Of Medicine last year.

The older one gets, the higher the likelihood of having to deal with a painful condition.

Yet, many of the elderly suffer in silence, because they are not able to express themselves or because they choose not to seek treatment.

The arthritic knee

Pain is, of course, a common symptom for many conditions.

While younger people may complain of pain from sports injuries, accidents and prolonged desk work, the wear and tear of the body is the biggest culprit causing pain to senior citizens, said Singapore General Hospital's Pain Management Centre director Tan Kian Hian.

About four in five of the centre's older patients suffer from degenerative pains, mainly from arthritis or joint damage.

Many of them would tell of how they used to carry heavy flowerpots or their grandchildren, which might have hastened the joint degeneration process, said Dr Tan.

Among the elderly, the most common form of arthritis is osteoarthritis, where progressive wearing down of the cartilage lining the bones occurs. The bones then rub against one another, causing swelling and pain.

The local study also identified musculo-skeletal pains as the pain most prevalent in adults, with the knees bearing the brunt of it.

When osteoarthritis of the knees occurs, pain can arise after prolonged standing or walking or when one is carrying something heavy, said Dr James Low, a senior consultant and the head of the department of geriatric medicine at Alexandra Hospital.

The pain, which may be sharp or dull, can be accompanied by swelling, stiffness and crepitus - that crackling sound in the knee.

In severe cases, the pain can come even when the person is resting, said Dr Low.

Slipped disc and sports injuries

Frozen shoulder, slipped disc

Another common condition is frozen shoulder, which is characterised by dull aches and stiffness. One may find it difficult to do everyday activities like combing one's hair or putting on a T-shirt.

Frozen shoulder occurs when the joint capsule becomes inflamed, scarred or shrinks.

Carrying too much weight and having a back injury can lead to another common problem - the faster degeneration of the spinal discs which act as cushioning for the vetebral bones of the back.

A disc may tear or bulge. This condition is more popularly known as a slipped disc and it may press onto the surrounding spinal nerves, causing a sharp pain that can radiate from the lower back all the way to the feet in a condition known as sciatica.

Doctors say the effects of degeneration can be felt as early as middle-age, when a person is in his 40s or 50s, but will get worse after he hits his 60s.

Risk from sports injuries

People active in sports may be more prone to aches and pains later in life if they have had injuries.

Sports injuries can result in the disruption of the joint structures, for example, the meniscus (cartilage) of the knee or the cartilage of a joint. This can lead to an increased risk of osteoarthritis, said Dr Jason Chia, a consultant sports physician at the Changi Sports Medicine Centre and the Singapore Sports Medicine Centre.

As one ages, Dr Chia said, there is loss of muscle mass, flexibility and coordination. This makes the musculo-skeletal system less able to take the rigours of physical activity and can result in injury.

Musculo-skeletal pains can also come from fractures, for example, in the hips or spine, due to wear and tear or falls, said Dr Low.

This is common in older folk with osteoporosis or brittle bones.

Some senior citizens regard the general pain they feel as rheumatism but this is a vague term, said Dr Low. Rheumatism can refer to various painful medical conditions which affect bones, joints, muscles and tendons and arthritis is often part of the rheumatism family.

Nerve pain

Nerve pain

Another type of pain that commonly afflicts the elderly is nerve pain caused by shingles.

This happens when the virus that causes chicken pox in a young person lurks in the body and goes on to cause the painful shingles rash when the person is older. Usually, those above 50 are more susceptible when their immune system weakens.

This pain, which has often been described as stinging or stabbing, can last for weeks and months even after the rashes have subsided.

Diabetic patients may also experience a tingling pain in their feet and hands in a condition known as the 'stocking and glove' pain.

Diabetes, a chronic disease seen more in middle-aged and elderly people, can damage nerve endings and cause numbness and pain in the extremities.

More than half of diabetes patients may be affected by some form of nerve disorder and the risk increases with age and the duration of the illness.

Older cancer patients have to deal with pain from the cancer itself as well as the treatment, said Dr Tan.

Pain management

While the Pain Association study found that one in five of the elderly may have chronic pain, the figure may be higher, especially for those in nursing homes or who are cognitively impaired and unable to express themselves, such as dementia patients.

Another study conducted in nursing homes here and published in the Clinical Journal Of Pain in 2007, showed that 42.9 to 48.7 per cent of nursing home residents had some form of pain.

Pain can be managed or treated if help is sought, said doctors.

When medicine fails to reduce pain or causes intolerable side effects, other treatment methods available include nerve blocks, radio-frequency treatment and joint injections.

Some patients turn to traditional forms of treatment like acupuncture.

However, many cases may have gone untreated or some may have tried self-medication.

Given the ageing population here, doctors expect the number of people plagued by pain to continue to rise.

Many of these conditions are not life-threatening, but doctors warn of other more sinister pains.

These include chest pains, which can signal a heart attack, or pains that arise because the patient has a more dangerous condition such as a tumour or infection, said Dr Low.

Hence, it is important that the elderly and their care-givers take all pain symptoms seriously.

This article was first published in Mind Your Body, The Straits Times.

Purchase this article for republication.

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