Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain - Michael K. Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin (2012)

Chapter 19. Pain Self-Management for Seniors

Over the last 5 years we have been testing the methods outlined in this book with people aged over 65 years (and up to 90) who were seeking help for their chronic pain. We have found that these methods can help older people, but as with younger people, you have to do them regularly for several weeks before you will see benefits. But there are some differences between younger and older people with pain that are worth knowing about.

On the positive side, our research (and research by others) has found that older people with chronic pain are generally less distressed about it than younger people. The older people seemed to be more accepting of their chronic pain and realize they do have to learn to live with it.

On the negative side, older people with chronic pain are more likely to have other conditions as well (like osteoarthritis, blood pressure problems, heart disease, respiratory illnesses, and so on). These other conditions do need to be considered when planning your pain management program, so we suggest you discuss your plans with your doctor. This applies especially to your exercises and medications. A few key points should help older people make best use of the book.

Medications

Many people over 65 years of age will be taking medications for medical conditions other than pain, and they often want to avoid taking pain medication if possible. One of the important points here is the risk of adverse interactions between your pain medications and other medications (like drowsiness, stomach and bowel problems). But it is important not to add or change medications without discussing it with your doctor first. If you do want to minimise your pain medications, the methods described in the book can help.

Remember, for many older people staying active and independent are more important goals than waiting for pain relief. So, exercises can help here.

Exercises

The chapters on setting goals (Chapter 7) and pacing (Chapter 8) were found to be very helpful. So, developing a brief activity upgrading and exercise plan is a good place to start.

As we mentioned in the exercise chapter, the exercises are to help you get moving (and to keep moving), rather than to relieve pain. The basic message is: if you are active but in pain you will have a better quality of life than someone who is inactive and in pain.

Several of the exercises described in the book will be too demanding for many older people and you should start by selecting the ones you think you can manage. If you can discuss it with a physiotherapist that is better still.

Many older people are not comfortable with gyms, so doing these exercises in a room with enough space at home is fine. Doing the exercises with another family member or a group of friends can help to make them more fun.

Doing exercises with a group in a heated pool is also popular with older people and worth trying. But as we don’t live in the water it is important to exercise on land too.

For resistance work you can use either the commercially available rubber stretch-bands (sometimes called Thera-bands) or light weights (like barbells) that can be bought at sports stores. Alternatively, put small tins of food in a light bag and use them.

Do try to use your exercise chart from the book and to pre-set the exercise quotas at least a day (or week) before you do them. Check them off on your exercise chart as you achieve your quotas. Gradually, you should try to pace up your quotas as we discussed in Chapter 8 (on pacing). Show your exercise chart to your doctor (and physiotherapist, nurse, or family members) every few weeks so they can see what you’re able to do.

Goal setting

Try to start with small, achievable goals, like walking to a neighbour’s place or sitting through a meal. Then gradually aim higher, for more ambitious goals that you’d like to achieve. As always, pacing is essential for sustained improvement in functioning.

Keep a chart for recording your goals and tick them off as you achieve them - that is usually quite rewarding. Remember, it is you who has done it and you’ve done it now despite your pain.

Thought management and relaxation

Unhelpful thoughts about pain and other problems do make managing pain harder. Thoughts like “I can’t go on” or “I can’t cope with this” will make anyone feel hopeless, even if they seem realistic. These sorts of ‘catastrophic’ thoughts are still just thoughts. We don’t have to go along with them, but it helps to recognise you’re having them in order to manage them.

To manage unhelpful thoughts we suggest you try to put them to one side (without fighting them or trying to stop them - that can even encourage them). Instead, try to focus on what you want to do - your immediate goal, like getting out of bed or have a short walk. Then work out how you’ll do it, accepting the pain will be there but it doesn’t have to stop you. Plan your activity and remember to pace yourself, a bit at a time.

If you are feeling stressed or worried you might also like to try the relaxation technique as well (see Chapter 12). This means using your breathing to let go a bit of tension each time you breathe out. The aim of this is to help you manage, not to take the pain away.

We recommend you use the relaxation technique while you are doing other things, including exercising. This means just letting go as you breathe out while you exercise or walk or whatever. You may not become as relaxed as you might in a quiet place but it will help you to stay as calm as possible in a stressful place.

The attentional technique of desensitizing we describe (Chapter 13) is also worth trying along with the relaxation technique. It’s a bit like confronting your fears. Just calmly go into your pain sensations with your mind with as little reaction as possible, observe the sensations without trying to change them or even think about them. See what happens instead of thinking about it. It is intended to help you lessen the impact of pain rather than lessen the pain. Treat it as an experiment, but you will need to practice it several times a day (and at night in bed) to get the most out of it.

Communicating with others

As we discussed in Chapter 16, it is helpful to tell people you’re close to about your pain management plan, so they will understand when you are pacing your activities and can encourage you to keep working on it. Explaining your program to them (even get them to read parts of the book) can also help to reduce their worries about you and concerns they may have about your pain not going away.

Maintenance

A key finding in our research was that other events in your life will often get in the way of keeping to your pain management program. Events like getting a cold or another illness, as well as extra demands from family or friends (who might also get sick or have some infirmity). These disruptions are to be expected and you can only try to work around them as best you can. If you can’t do your exercises for a week or so, that is OK. Just try to get back to them as soon as possible, but remember to start with a little less than you were doing before the stoppage, then pace yourself back up.

Of course, even if you can’t manage your exercises you can often still work on your pacing and thought management, as well as the relaxation technique.

Finally, try to give yourself regular pats on the back for your efforts. You’re still trying even if you can’t be perfect. No one else can either.