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  • John Seivert

Aging and Four Pain Myths

Updated: Sep 1

Almost daily I am told by patients that their joint pains are due to aging and there is nothing they can do about it. I’m also told buy these patients that their healthcare providers, family, friends and colleagues agree with them. Due to the belief that if you have discomfort or pain in the lower extremity joints or low back you should stop doing that activity. In physical therapy practice, we see many people over the age of 50 stop doing the very things that could help them the most, like jogging, cycling, hiking or regular walks with the dog. Why is that? Why do people over the age of 50 stop exercising when they experience pain? Let’s take a look at some of the research done around the 4 pain myths and how they complicate healthcare.


Myth #1 Pain is a natural part of aging.

Surveys among patients 70 years old or older being treated for osteoarthritis in primary care report that they believe people should expect to live with pain as they get older. I have even heard patients state, “That’s how you know you’re alive, everything hurts.”

Many studies do support the fact that chronic pain is common in older adults (A prevalence of 50% of patients treated in primary care). However, the National Center for Health Statistics found an interesting finding. They report chronic pain among the elderly actually decreased after the age of 65 and further decreased after the age of 85.

Many chronic pain disorders occur less frequently with advancing age. Population based studies have found a lower prevalence of low back, neck and face pain among older adults compared with their younger counterparts. There is also evidence for less headaches and abdominal pain. These studies and many more refute the stereotype that advancing age inexorably involves pain and challenges the belief that pain in the aging adult is normal and expected, and unworthy of treatment.


Myth #2 Pain worsens over time

In a study of community-dwelling older adults, 87% of those surveyed rated the belief that more aches and pains are accepted part of aging as definitely or somewhat true.

Some studies have linked older age with a worse prognosis for patients with musculoskeletal pain, but a growing and larger body of research has shown that aging has no effect on it.

Pain does not always progress. In a large cohort of patients with extremity joint osteoarthritis, radiographic joint space narrowing worsened over 3 years, but this did not correlate consistently with worsening pain. This group was assessed 8 years later and found there was a significant variability in pain, with no clear progression.

In another study of elderly patients with low back pain, the pain was frequently short lived and episodic and did not increase with age. Another study of patients with knee OA identified factors that were protective against a decline in pain-related function: These were good mental health, self-efficacy, social support, and greater activity – but not younger age. These studies are powerful messages to all of us that pain does not worsen with age.

Many chronic pain disorders occur less frequently with advancing age. Population based studies have found a lower prevalence of low back, neck and face pain among older adults compared with their younger counterparts. There is also evidence for less headaches and abdominal pain. These studies and many more refute the stereotype that advancing age inexorably involves pain and challenges the belief that pain in the aging adult is normal and expected, and unworthy of treatment.



Myth #3 Stoicism leads to pain tolerance

In one survey, older adults were more likely than their younger counterparts to express this stoicism.

The degree of pain is more strongly associated with depression in older patients compared with younger adults, and greater pain reduces the likelihood that depression will improve with treatment. Pain also continues to interfere with sleep. In one national sample, 25% of patients with arthritis said they suffered from insomnia, which was twice the prevalence of insomnia found in subjects without arthritis. Being stoic about pain does not diminish its consequences or help patients tolerate pain any better.


Myth #4 Prescription analgesics are highly addictive

I wrote about the opioid epidemic in this column back in April of this year and we all can agree that opioids are not the way to treat musculoskeletal non-cancer-causing pain.

So how great is the risk of addiction? For older adults, it’s very low. In a retrospective cohort study of older patients who had recently started a course of opioids for the treatment of chronic pain, only 3% showed evidence of behaviors associated with abuse or misuse. Long term opioid use among older patients with painful conditions is relatively uncommon, and prescription patterns suggest that most older adults discontinue opioids after one or two prescriptions.

In Summary, the research has shown that pain is not a natural part of aging. Chronic pain in the elderly often improves or remains stable over time, stoicism does not lead to acclimation, and pain medications are not highly addictive in older patients. It is very important to counter these stereotypes with evidence-based findings for older adults suffering with chronic pain. Patients need an accurate musculoskeletal evaluation and a thorough treatment plan that addresses all their painful regions. If you are elderly and suffering from musculoskeletal pain consult with your physician and ask for a physical therapy referral to get moving again in a safe and pain-free manner.


#4PainMyths #PainfreeAging #Opioids

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