“I have pain in my knee that every two or three weeks leaves me without the strength to even walk.” “My lower back hurts every morning when I wake up and it takes me a while to be able to move normally.” “I have permanent pain in my shoulder that doesn't even let me sleep.” These complaints begin to be common and become almost part of normality for many people as they age, and especially after the age of 60, when many experts agree that the “it hurts” that they manifest in consultations increase significantly.
According to data from the Pain in Europe study extracted from the Guide to good clinical practice in geriatrics: chronic pain in the elderly, prepared by the Spanish Society of Geriatrics and Gerontology, 11% of the Spanish population suffers from chronic pain, a percentage that is skyrocketing. up to 70% in the population over 65 years of age.
“We must understand that our body is in continuous “internal movement” at the cellular level. Cells are like small factories that produce waste material that continually has to be expelled. With aging, these factories begin to fail,” explains Dr. Sara Laxe, rehabilitation doctor and director of the Scientific Committee of the Spanish Society of Physical Medicine and Rehabilitation (SERMEF).
According to Laxe, these failures translate into genomic instability that causes the mutations that always occur to not be repaired, the telomeres and mitochondria begin to work poorly and, as a consequence, waste substances accumulate: “Then what appears It would be called a systemic inflammatory process as a result of cellular senescence. And this produces pain.”
According to the Research and Innovation coordinator at the Hospital Clínic of Barcelona, however, although it is “inevitable” to live with some type of pain as we get older, “that does not mean that we have to resign ourselves and not ask the professional for help so that "It helps us understand what is happening, what causes it may have and what treatments exist."
An opinion that is partly supported by Dr. Javier Gómez Pavón, head of the Geriatrics and Palliative Care Service at the Central University Hospital of the Red Cross of Madrid and member of the Spanish Society of Geriatrics and Gerontology (SEGG). Pavón points out that pain as we age should not be assumed to be normal, but rather that it is synonymous with pathological aging. “Pain should never be normalized. Pain is a physiological mechanism of the human body that indicates that there are alterations in the body. Therefore, if pain appears, it is always an alarm signal that your body needs help,” he points out.
Gómez Pavón explains that middle age (50-60 years) is marked in red today as one of the most important stages when determining the type of aging we are going to have: either healthy and satisfactory or marked by poor health and the risk of chronic diseases. Not in vain, pain affects people's general health, as demonstrated by a British study that analyzed the implication of hip and knee pain on people's general health. The result? Those people over 65 years of age who lived without pain had a general health status similar to that of people under that age. The same did not happen with people who lived with pain.
Hip and knee pain, precisely, are, according to experts, two of the most common, along with spine pain (at the lumbar and cervical level), shoulder pain, and hand and foot pain. The latter are fundamentally due to osteoarthritis - especially in people with manual jobs - and chronic basic problems such as flat feet, cavus or plantar problems that alter the dynamics of the step and thus the spine, favoring osteoarthritis and cervical pain. and/or lumbar.
“When at this age the body shows signs of discomfort and especially pain, it is indicating that “something is starting to go wrong,” says the SEGG spokesperson, who points out that the chronic pain pathway (spinoreticular pathway) is linked to a hyperexcitation of the nervous system that makes rest, concentration, memory, emotion and affectivity difficult: “In short, it makes daily life difficult, because pain becomes the center of it, making it difficult to carry out activities of daily living. ”.
But pain, as noted at the beginning, is not inevitable. And it can even be reversed. And, as Dr. Javier Gómez Pavón points out, if in this middle age good lifestyle habits are acquired, the physiological reserve against aging will increase - especially at the level of the musculoskeletal system - and with it our “defenses” against common chronic diseases. of age such as osteoporosis-osteoarthritis.
"If your diet is not adequate in proteins and micronutrients (Mediterranean diet) and is combined with poor body hygiene with a sedentary lifestyle, sarcopenia (decrease in quantity and quality of muscle) will be unstoppable, which will cause less resistant bones with continuous alterations that They will begin with the alarm bell of “pain-discomfort” and with vicious circles of increased sedentary lifestyle, overweight, more sarcopenia, fewer social relationships, more loneliness, less physiological reserve and more “it hurts” in all systems.”
In addition to lifestyle habits, Javier Gómez Pavón recalls that today there is “a large therapeutic arsenal” (paracetamol, second generation NSAIDs, opioids, neuromodular drugs, etc.) to address pain that must be managed in the first instance. by transversal doctors (primary care, geriatricians, internists with rehabilitation support, traumatology, rheumatology among others depending on the cause) and, when they cannot control the pain, by the Pain Units that exist in the vast majority of Spanish hospitals.
“In this sense, a call to attention is necessary to the current problem that is emerging of inappropriate treatments and abuse of painkillers such as opioids or cannabinoids with harmful and unwanted effects such as addiction, among others,” reflects the expert, who highlights Furthermore, all treatment must be accompanied “to improve its effectiveness” by non-pharmacological measures of good health habits such as those described above.
Gómez Pavón's opinion is shared by Dr. Sara Laxe. “We know that the practice of intense and vigorous physical exercise reduces, among many other things, pain,” she points out. But she believes, however, that in this regard there continues to be a great lack of knowledge on the part of the general population. “There are many people who think they are doing physical exercise and what they are doing is physical activity. Walking is not exercise. And there are also patients who go to the gym and do not do the exercises well, which can ultimately be counterproductive and increase pain in the muscles involved,” explains the expert.
Laxe, in this sense, recommends prescribing exercise to patients based on the acronym FITT (Frequency, Intensity, Time and Type): “There are many types of exercises. Strength exercises, resistance exercises or aerobic exercises. All of this must be adapted to the patient's context, both on a physical level - taking into account her injuries - and also on a cognitive level.
Finally, the Research and Innovation coordinator of the Hospital Clínic positively values the contribution of physiotherapy as an adjuvant treatment, although she points out that when there is multiple musculoskeletal pain in different locations or deep-seated chronic pain “you have to think about a very specific approach. more multidisciplinary, much more holistic and integrative, because probably physical therapy in isolation may not be entirely useful.”
Sara Laxe, however, recognizes the influence on everything related to healthy habits of the social and economic determinants of health, which cause many people today to have problems eating well, sleeping enough, doing physical exercise and/or be able to afford the assistance of a physiotherapist. “One of the main causes of pain is stress. Chronic stress generates a series of changes in our metabolism that implies failures in cellular repair. There is a lot of evidence that having a low socioeconomic level influences suffering from pain,” says the doctor. He tells La Vanguardia that many people come to his office suffering from pain and very limited in their daily lives who, however, do not really have any physical problem that justifies it, such as a fracture, a tumor, or osteoarthritis. severe.
“When I dig a little deeper in the interview, you find truly devastating panoramas at the level of work, social, family fragility, and even cases of abuse and mistreatment. Sometimes it's hard for me to hold back my own tears when I see them cry. If these aspects could be controlled, the pain would be less," says the SERMEF spokesperson, who considers that any solely medical initiative focused on solving chronic pain "is doomed to failure if it is not combined with a well-being policy focused on ensuring access to decent housing and work, as well as ensuring a balance between personal and professional life.”
