A new look at chronic back pain
WITH chronic back pain numbers among seniors increasing, pain specialist Associate Professor Malcom Hogg offers some sage advice on how to manage it, and if possible, prevent it.
"We know that chronic pain in general increases with age, and in particular, there is an increase in frequency of musculoskeletal pain conditions," the Royal Melbourne Hospital pain clinic head and Pain Australia board member said.
This is likely to happen because of accumulated injury or as earlier trauma progresses to arthritic degenerative changes, age-related changed to both bones and soft tissues where the spine changes shape and you lose height, and where people have difficulty in recovering from pain at a nerve level.
Dr Hogg recommends that seniors ensure they have a broad, multi-dimensional assessment of their back pain.
"The assessment of back pain in older people is complex and needs to be done over several sessions in combination with a general practitioner, a physiotherapist and possibly some surgical assessment," Dr Hogg said. Approaching it this way will help to gain a full understanding of it and exclude serious causes of the pain.
Other stratgies are -
- For common causes of back pain, improving posture and increasing activity such as walking, doing exercises to strengthen the muscles, and linking this in with weight loss.
- Medications are another option. Paracetamol or anti-inflammatory drugs can be used with caution as they may have side effects in an older person. In some cases, low-dose opioids can be used. In other occasional cases nerve medications may be used.
- Injections are used to target arthritis or nerve pressure, after a specialist has assessed the pain.
- Surgery is used where there is clear compression on the nerves creating nerve-related pain or if there is instability between the vertebrae.
"Even if people don't have pain now, they should be actively managing muscle, joint and bone health," Dr Hogg said. To do that he recommends -
- Take calcium and Vitamin D for bones.
- Participate in low-grade exercise program.
- Be careful with lifting.
- Pace activities.
"Back pain is so common as we age, we should be doing some preventative work," Dr Hogg said. "The problem with managing pain once it is established in the back is none of our treatments are particularly good because the process leading to the pain is well advanced.
"We don't have a fix once you have thin bones and fractured spine. We can't repair that. What we can do is restore some function."
The best choice is regular walking Dr Hogg said. While it might increase the risk of falls, Dr Hogg recommends wearing appropriate shoes, staying on flat surfaces and walking carefully with a good posture. "You walk to help your breathing and muscle tone around your spine, and that helps prevent backpain," Dr Hogg said.
For more information, go to www.painaustralia.org.au.