Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

From the Summer of Love to Senior Citizen

Yes, the baby boomers are now receiving Medicare cards.

Yes, the baby boomers are now receiving Medicare cards. By 2030, approximately 20% of United States citizens will be at least 65 years of age, according to the Institute of Medicine’s report issued in 2008; this is up from only 12% three years before.

This increasingly large demographic will be making increasing demands on the health care system, perhaps rendering it more difficult for physicians to discern subtle changes in patients that could, if not addressed promptly and appropriately, lead to major and possibly catastrophic health problems in the future.

For example, a health care provider needs to take quality time to assess for any changes in mood or thinking, dimming vision, or fading hearing—all of which could lead to altered perception of simple realities of daily life, making the patient more vulnerable to falls and thus chronic pain and disability. Under the Affordable Care Act, certain preventive medicine services will now be covered, including so-called wellness visits, which it is hoped will give an incentive for physician to spend more time with the patient and perhaps along the way uncover incipient problems that have the potential to become immense as the years progress.

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Returning to the hearing loss issue, a study published a few months ago in the “Archives of Internal Medicine” found that those patients with at least mild hearing loss were almost three times likely to have fallen in the previous year. This might be explained by an inability to become aware of environmental cues that could avoid the fall; or there might be a concomitant inner ear problem affecting balance.

Almost 45% of adults in their 60s have at least mild hearing loss in one ear, and over 25% have such loss in both ears, according to a study published last year—also in the “Archives of Internal Medicine”.

Other problems encountered by an aging population include impaired judgment, arthritis impacting the ability to lift the foot high enough while negotiating, say, a stairway, or neuropathy negatively impacting the ability of one to “feel” the ground under one’s feet. Cognitive changes could be related to too many medications with the potential for adverse drug interactions, or drugs that in and of themselves impact cognitive function, most likely due to their sedating effects.

Of course, it will not be too difficult to find patients in this older population who deny they are aging and thus subject to all the health difficulties that accompany aging.

To convince the recalcitrant is the role of the art of medicine.

Spend time with the patient. Search for clues that could uncover subtle changes that if unchecked could lead to disastrous consequences.

This involves skills not necessarily taught in medical school. The last I looked, it was called being human.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.


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