Senior Living: The helpful and hurtful sense of pain


By Dr. Thomas LaGrelius

Contributing writer

There are too many kinds of pain. There is acute (immediate) injury pain, which is often very useful. Put your finger on a hot frying pan and it hurts. That reminds you to remove your finger, unless you are very foolish, and put it quickly under a cold water stream for several minutes, minimizing the damage.

If you fall and fracture your ankle it reminds you to stay in your cast/boot and limit your activities for the six to eight weeks it takes to heal. Perhaps it also reminds you to be more careful, wear better supportive shoes ALL the time, and watch where you are going. Prevention is a whole lot better than treatment.

Chronic (long duration) pain is the kind many seniors simply live with and wrongly assume is part of aging. It is often due to worn out “osteoarthritic” joints like knees, hips, shoulders and spines. The disease stimulates nerve pain receptors in such joints.

Sometimes pain is due to the nerve itself malfunctioning. This is “neuropathic” pain and the disease is in the sensory nerves themselves. These two types of chronic pain are quite different and managed differently. Neuropathy pain may be the subject of a future column.

Senior Living: The helpful and hurtful sense of pain Dr. Thomas W. LaGrelius

Loneliness, depression and anxiety are truly painful, perhaps the most painful things humans can experience. They can also make physical acute and chronic pain much worse than it otherwise would have been. Depression often accompanies chronic pain and can also cause it. Depression can be and needs to be treated.

Positive attitude makes a difference. I have seen patients with severe arthritis who find a way to use the joint and claim to have little or no pain. Almost always these patients are naturally happy, optimistic, busy folks who somehow ignore the disease that would cause severe pain for many of us. I wish I could bottle and prescribe that.

Pain is not actually a “normal” part of aging. Between 15 and 50 percent of seniors deny living with any chronic pain at all, but the flip side is that 50 to 85 percent say they do. It is my job to eliminate that pain, or reduce it to a level the patient considers “tolerable” and allows the best level of activity and function possible.

What drugs do we use for chronic pain?

We use several drugs, but the first thing we often do is put patients on relatively high dose, scheduled acetaminophen (Tylenol is the commonest brand). In the hospital we often use it intravenously.

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A lot of pain drugs cause more problems than benefits for seniors, who are far less tolerant of drug side effects than younger folks. Narcotics (morphine, codeine, oxycodone, etc.) in particular can be hazardous drugs for seniors when used for chronic pain. They cause depression, constipation, nausea, falls, delirium and confusion, and can rarely even make pain worse. I am often asked why I use so few narcotics for chronic pain, and these are the reasons. Narcotics are more useful, used briefly, for acute injury pain.

However if you are having a heart attack with severe chest pain, or have a fractured pelvis, you definitely should get lots of IV morphine. That’s the setting in which these drugs are useful.

Let’s say a patient has worn out knee or hip joints and is in 8 out of 10 pain when active, but little or no pain at rest. One thousand milligrams of acetaminophen (Tylenol) given three or four times a day on a SCHEDULED basis (not just as needed) will often by itself get the pain down to a tolerable level and allow active use of the joint. It can make the difference between a patient who spends his day doing no physical activity in a chair, and one who can remain up and active.

It is hard to convince patients of the great value of scheduled acetaminophen (Tylenol). It is an amazing drug. It is cheap, extremely safe, very effective if used often and scheduled, and is almost free of side effects. It does not hurt your stomach, cause ulcers or bleeding, raise your blood pressure or damage your kidneys like ibuprofen (Advil) or naproxen (Aleve) can, and it works at least as well for most pain. Studies have even shown it can work as well or better than narcotics.

The only patients who need to be careful with acetaminophen are folks with liver disease. The maximum dose is four thousand milligrams per 24 yours, but three thousand is what we usually use. It’s important to take it “lock step”, on a schedule, and not wait till you “need” it. Set an alarm for every six hours, and take it when it rings, before the pain really bothers you. If you have any kind of chronic pain, and your doctor says it’s safe, try it!

Ice is a great pain reliever, especially for acute injury pain.  Use the acronym “RICE.” It stands for “Rest, Ice, Compression and Elevation”. Whatever you injure, put it at rest up in the air, ace wrap it if possible, ice it and take one thousand mg of acetaminophen. I promise you in an hour it will be better.

Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance www.skyparkpfc.com. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital.  Email questions and topic suggestions to [email protected]


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Source:  https://www.dailynews.com/2019/01/12/senior-living-the-helpful-and-hurtful-sense-of-pain/



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