Older adults are more susceptible to pain. Does that mean you have to live with it? “No,” says Lauren A. Kelly, MD, a geriatrician at The Mount Sinai Hospital. “Pain is more common as we get older, but it should never be dismissed as a normal part of the aging process. There are a lot of consequences to living with pain, and in many cases, it’s treatable or preventable.”
Lauren A. Kelly, MD
In this Q&A, Dr. Kelly, Assistant Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, explains what you should do if you have pain, what to expect, and how to talk to your doctor about your pain.
Where should I go to get treatment for my pain?
A great starting place is primary care, especially if you trust your primary care doctor and you’re happy with them. A primary care doctor can assess the situation and make referrals as needed.
In addition to primary care, there is a broad range of specialists who treat pain, including interventional pain, physiatry, neurology, surgery, palliative care, geriatrics, and integrative medicine practitioners. Even behavioral health specialists like psychiatrists and therapists can play a role.
What does an assessment consist of?
Assessment needs to take a whole person approach, considering how well a person is able to move through the world while living with their pain. This includes activities of daily living, such as dressing, showering, using the bathroom, as well as more complex tasks that contribute to independence such as managing money, cooking, and shopping. I find that understanding a patient’s daily challenges is much more helpful than identifying pain on a scale of 1-10. It is also important to understand how pain is interacting with our mood and our thinking (cognition), as pain is not simply a physical experience of the body but rather a condition that affects the total person: mind, mood, and body.
How should I talk to my doctor about my pain?
It is important to tell your doctor the details of your pain. How long have you been dealing with it? What are the descriptors of the pain? Is it sharp, aching, dull, burning, stabbing, shooting, numb, or tingling? How does it affect your function? Does it make it hard to get yourself out of bed in the morning? Is it challenging to shower? Are you not able to go grocery shopping? Are you communicating less with family and friends and leaving home less often? It’s important to share this information with your doctors so that they can best direct a pain treatment plan.
Why do some people avoid getting help?
Many patients shrug off pain as though it’s a normal part of aging, and this leads them to report it less to their doctors. Ignoring pain, however, can lead to more injury and disability. Often, older adults don’t want to call attention to their painful impairments. It can be a difficult transition for some older adults to begin using an assistive device like a cane or a walker. It can also impact our sense of self or independence to accept additional help at home when needing assistance to ensure our daily needs are being met. Some of my patients will go to great lengths to minimize their impairments in order to try and maintain autonomy. What I try to emphasize is that these modifications are not to diminish independence but to promote safety, prevent disability, and improve function and quality of life.
How can physicians be better advocates for patients experiencing pain?
One attitude to avoid is this: “Oh well, the patient is just getting older, and they’re going to have pain.” That’s a common misunderstanding on the part of some physicians and allied health professionals. We’re in a position where pain is being underreported and undertreated. We need to recognize that there’s a lot that can be done for pain, and it’s important for patients and/or their caregiver(s) to be strong advocates for improving their quality of life.