Pain management of older persons: physiotherapy is a hope
Pain in older people is highly prevalent and regarded as 'normal' in later life. Hence, sufferings associated with persistent pain in older people often left without the appropriate assessment and treatment. The impact is significant and of great concern. Pain in older people is an increasingly important health issue, and one that requires urgent attention.
Chronic musculoskeletal pain is the most common, non-malignant disabling condition that affects at least one in four older people. The most musculoskeletal pain in the joints of the upper and lower extremities, especially hips, knees, and hands, is associated with the degenerative changes of osteoarthritis. Older adults may also develop tendonitis and bursitis, as well as inflammatory joint and muscle disease. The most common painful musculoskeletal conditions among older adults are osteoarthritis (OA), low back pain, fibromyalgia, chronic shoulder pain, knee pain, myofascial pain syndrome and previous fracture sites.
Physiotherapy interventions reduce stress and correct malalignments of joint structures, correct muscle imbalances, and enhance the shock absorption capacity of tissue structures.
Manual therapy
There are evidences on the use of joint mobilisation, stretching, neural mobilisation and manipulation specifically for older adults, research has addressed the use of these treatments for knee and hip OA, conditions common in older adults. The benefit of manual therapy on pain and function for knee or hip OA is higher.
Electrotherapy
Superficial heating agents (e.g. hot packs, warm hydrotherapy, paraffin, fluidotherapy and infrared) or deep heating agents (e.g. short-wave and microwave diathermy, and ultrasound) can be used to increase blood flow, membrane permeability, tissue extensibility and joint range of motion in ways that can contribute to decreasing pain.
Protective and supportive devices
Protective and supportive devices assist a decrease in pain and increase in function for patients with joint instability or malalignment. Therapeutic taping for patellar realignment is effective in reducing pain and improving function in patients with OA of the knee.
Transcutaneous electrical nerve stimulation
High-frequency Transcutaneous electrical nerve stimulation (TENS) appears to be the most effective TENS application for post-surgical pain and can be used with modulating frequencies to control neurologic accommodation.
Cognitive behavioural therapy
The American Psychological Association recognises cognitive behavioural therapy (CBT) as an empirically supported intervention in management of chronic musculoskeletal pain; including rheumatoid arthritis, osteoarthritis, fibromyalgia, and low back pain.
Exercise
In recent years, exercise is getting the most important component of chronic pain management. Regular exercise, interventions to increase physical activity, strengthening the muscles, accompanied with weight loss are effective methods in the management of OA, low back pain etc. in older adults.
Regular exercise as an important adjunct to other interventions (e.g. thermal agents, patient education etc.) is the most frequently preferred pain management strategies after medication in some older adult populations. Some common types of exercises include flexibility, strengthening, aerobic and aquatic exercises.
A professional physiotherapist is the right person to decide a comprehensive exercise programme for any individual. Exercises are not general to all. Every individual is unique and for that reason, exercise should be very much individual.
The writer is a physiotherapist working at BRB Hospitals Ltd.
Email: dr.bjoy@gmail.com