HURT FEELINGS
Coping with Chronic Pain
A noted pain doctor’s prescription for relief
For many seniors like me, chronic pain can be a pain in the … uh … everywhere.
We ache. We’re stabbed. We burn. We’re pricked. We feel pins and needles. We have flares in the legs, pelvis, torso, neck, or head. We hurt.
In my case, my chronic pain is due to severe osteoarthritis throughout the body caused by a rare genetic disease. I’m unusual in that, at age 66, I’ve had eight joint replacements (both hips twice, both knees, both shoulders), but other seniors may have pain caused by any number of conditions: musculoskeletal aging, diabetes, fibromyalgia, and more.
I cope with my pain by writing, my profession for more than three decades before I was forced to retire due to disability. In fact, I am authoring a book called “Hurt Feelings: Inside the Emotions of Living in Chronic Pain.” (I’m seeking stories of fellow chronic pain sufferers; see bio below.)
Part of my motivation is to explore how I can deal with pain as I age. Unfortunately, chronic pain is a common companion of getting older. According to the National Institutes of Health (NIH):
An estimated 65 percent of U.S. adults over the age of 65 report suffering from pain and up to 30 percent of older adults report suffering from chronic pain.
For “Hurt Feelings,” I interviewed noted pain specialist Andrea Furlan, MD, professor of medicine at the University of Toronto, and author of the book “8 Steps to Conquer Chronic Pain: A Doctor’s Guide to Lifelong Relief.” Based on her experience with thousands of patients, she has some insights into pain and how to deal with it.
Dr. Furlan observes that most doctors aren’t very good at treating pain:
Because chronic pain [lasting longer than three months] is different from acute pain [resulting from injury or illness lasting less than three months], many people, including the medical professionals, do not know how to treat chronic pain. They use the same tools for acute pain to treat chronic pain, and of course they will not get the same results. Therefore, people with chronic pain spend years and decades of their lives trying interventions that do not work for chronic pain.
Chronic pain is widespread, Dr. Furlan tells me, particularly among certain populations:
Women have more chronic pain than men. Older people have more chronic pain than younger people. Children also have chronic pain. Black, indigenous, and gender diverse people have more discrimination of what treatments they receive. People of low socio-economic status have less resources to manage chronic pain.
In her book, Dr. Furlan recommends creating a toolbox of therapies to cope with chronic pain. She writes:
I once met a young woman who had chronic pain since she was a teenager. She counted 102 strategies in her toolbox. She said she doesn’t have a toolbox, but a full-size garage-full of tools.
Not everyone needs 100 tools in their toolbox. I find that it is useful to have at least one tool from each of the five groups.
Dr. Furlan calls these groups the “Five Ms.” They are:
1. Mind-body therapies
When it comes to hurt, the body and mind are linked closely. Research — and my personal experience — shows that pain affects emotions and emotions affect pain. It’s a two-way street that requires attention to both , the physical and the psychological. But some people refuse to recognize the need for treatments such as Cognitive Behavioral Therapy (CBT). Dr. Furlan comments:
A person who does not see the connection between mind and body is usually fixated on the body. They are constantly looking for a quick fix, the magic pill, the other doctor who will discover what is wrong with their body or order the diagnostic test that has not been done. These patients are the ones who do not get better.
2. Movement
Motion is medicine. Although chronic pain often makes you want to slow down, movement ultimately keeps it at bay. The CDC recommends 150 minutes of moderate aerobic exercise per week for those 65 and over, something many senior chronic pain sufferers have trouble achieving. But any movement is better than being sedentary. Dr. Furlan observes:
“Movement” is more comprehensive than “exercise” because it includes any physical activity, even the activities you do at work, going to and from work, shopping, playing with your kids, hanging your laundry on the clothesline, or doing dishes.
3. Modalities
This refers to any number of treatments that relieve bodily pain. They are as simple as a heating pad for neck inflammation to small, through-the-skin TENS units that generate an electrical current to interfere with painful nerve signals. Dr. Furlan explains:
When I talk about modalities, I am referring to physical modalities, that is, therapeutic tools such as temperature, pressure, light, sound, or electricity. Heat and cold are excellent temperature modalities. (I also include orthotics and ergonomics under modalities, although they are not really a physical modality.)
4. Manual therapies
Masseuses, physical therapists, and some specialized machines use pressure on muscles and joints to relieve hurt. Dr. Furlan believes that massage and other types of manual manipulation can cut pain. She says:
Manual therapies involve some sort of hands-on therapy, or the application of pressure to the body using a machine or device. The three major types of manual therapies are massage, mobilization, and manipulation.
5. Medications
Dr. Furlan prefers other treatments than drugs for chronic pain that’s created in the brain, after a bodily injury has healed, called nociplastic pain. She allows, however, that medicine is sometimes needed. She urges caution:
All drugs have side effects and all of them lead to some changes in body functions. It would be much better not to take any medication, but that is unrealistic for some patients.
I don’t recommend that patients read the list of all potential side effects that can occur with drugs they are taking. That can trigger anxiety and a psychological reaction that causes your brain to make you think you are having all the side effects that you read about in the drug monograph. This is what we call the “nocebo” effect.
Nevertheless, it is important that you mention your concerns to your pain team.
I asked Dr. Furlan who should be part of a such a pain team. She says pain patients need multiple providers to find enduring relief, including a physician who understands the difference between acute and chronic pain, a mental health provider, a rehabilitation provider, a social services provider, and a personal coach, who could be a person with lived experience of chronic pain.
“What’s the single most important thing a pain patient should do?” I followed up. She replied, “Learn about chronic pain. Be the expert in pain neuroscience.”
Dr. Furlan has made a career out of helping people in pain. She has a personal connection to the hurt her patients feel:
I had debilitating menstrual cramps for many years during my teenage years and as a young adult. When I was in my 40s, I had two episodes of debilitating low-back pain. And when I turned 50 I had a terrible experience with shingles. I do have myofascial pain in my upper back. Fortunately, I do not have pain every day.
What motivates me is that I have helped thousands of people with chronic pain to regain their joy.
From my research with experts like Dr. Furlan and my personal experience, here are some things to remember if you are a senior in chronic pain:
You are not alone.
Millions of other seniors have chronic pain. In person and online support groups offer information and companionship. Seek one out at painconnection.org or through your local office on aging.
You can feel better.
As Dr. Furlan recommends, become a student of your pain. A good place to start is with her book, “8 Steps to Conquer Chronic Pain: A Doctor’s Guide to Lifelong Relief.”
You are not your pain.
It’s easy to become consumed with your pain. Keep in mind that you are more than your pain; you have a full life to live. Distract yourself by getting out of the house, seeing plays or movies, or pursuing interests and hobbies.
Find a purpose.
Pain is eased when you have a purpose in life, whether that’s work, helping others through volunteering, or taking part in your grandkids’ growing up. Consciously ask yourself: To what do I want to devote the rest of my life?
You are loved.
Chronic pain can be lonely and discouraging, but it helps to seek support from family and friends. Make your partner, relations, or close friends allies in your pain journey. There are people who love you and want to help.
Randall H. Duckett is writing a book about the emotions of chronic pain and invites fellow sufferers to share their stories. He can be reached at randall@hurtfeelings.life. He is also the author of Seven Cs: The Elements of Effective Writing (available on Amazon); learn more at randallhduckett.com.
