Are you treating the wrong kind of back pain?
Nearly half of all Americans 65 or older – 45.6%, according to the Centers for Disease Control – have back pain. Many may not be treating the kind of back pain they actually have.
Though “pain,” as in “back pain,” is a singular noun, it can have many different causes – and remedies.
A recent Boston University School of Medicine/Boston Medical Center study of 138 clinical trials examined medication options for seniors with neck and back pain.
Its main conclusion, says senior researcher, neurologist Michael Perloff, is that there’s no one-size-fits-all remedy.
Especially for older adults, the right medication choice depends on two things – the pain’s specific underlying cause and, what effect a given drug could have on co-existing conditions and on meds they’re already taking. “You do have to be careful about medication interactions and side effects,” he explains.
Many seniors may be treating the kind of back pain they used to have. For younger adults, back pains are mostly muscle-related. So a few days of ibuprofen, some soaks in the hot whirlpool, a few days of taking it easy, and, for bad pains, a muscle relaxant could do the trick.
But the more we age, the more we become subject to degenerative changes in our spines, resulting from decades of wear and tear on the cartilage discs that cushion our vertebrae and act as the spine’s shock absorbers.
As we age, those discs can dry up and lose elasticity, resulting in osteoarthritis of the spine. An estimated 89% of adults aged 65 or older have some form of it.
Sometimes those discs slip out of place, pinching nerves. One example of this is sciatica, where a pinched sciatic nerve radiates pain from the lower back do the back of a leg.
Another example is stenosis. Nerves pass down the openings in the spine, and when those openings narrow, the nerves get pressed and pinched. When that happens, walking and standing upright are painful.
Yet another is spondylolisthesis, where a vertebra slips forward over the one below it, pinching the nerve in between.
Older age is also a factor in sacroiliac joint dysfunction. These joints connect your spine to your hips, and when they become inflamed you can feel sharp pain radiating from your back to your groin and the back or outer side of your thigh.
Just as back pain can have many different causes, it can also have many different targeted remedies. As Dr. Perloff put it, “There’s a lot we can do with the weapons of medication, injections, physical therapy and, in some cases, surgery.”
Depending on the severity and duration of the pain, over-the-counter painkillers could help. Nonsteroidal anti-inflammatory drugs (NSAIDs), like Motrin (ibuprofen) and Aleve (naproxen) are more effective, but they come with risks of internal bleeding for seniors with stomach problems, kidney or heart disease, or who take blood thinners. That’s why Dr. Perloff’s team recommends limiting use – for two or three days during a flare-up, but not for weeks at a time.
Acetaminophen (e.g., Tylenol) products are safer, but even their arthritis variants are weaker.
There are specific medications for pinched-nerve pain like sciatica, namely gabapentin and pregabalin. But those come with their own side effects, including dizziness and loss of balance. For older people already taking meds that can cause dizziness and falls that could be a problem.
While muscle relaxants like carisoprodol and chloroxazone carry a risk of sedation and falls, low doses of others, including tizanidine and baclofen, can safely ease neck or back pain.
Some antidepressants – especially Cymbalta (duloxetine) – have proven helpful in trials; for a senior with back pain and depression symptoms, they could be a twofer.
For chronic pain that oral drugs can’t help, painkiller or anti-inflammatory corticosteroid injections may.
In the fight against back pain, there are even more precisely targeted weapons. Trigger point injections inject medication directly into painful muscle “knots.” Nerve blocks injections can cut off pain at its source. Radio frequency ablation “jams” pain signals by applying radio wave hear to specific nerve tissue. Implanted spinal cord-stimulating electrodes can emit mild electrical impulses that mask or divert pain signals on their way to the brain.
There are even more differences between one person and the next than between one kind of back pain and another. Different people are in different physical, mental, and psychosocial states. They have different relationships with their friends and families. They have different hobbies and interests, different preferences and values and are willing to make different trade-offs.
That’s why we never take a one-size-fits-all approach to senior care management. Instead, we design a holistic senior care management plan geared to each client's specific needs, values, preferences, and desire for independence, based on a thorough three-part needs assessment.
Please contact us to learn more about taking the pain out of senior care.