Musculoskeletal pain treatment can be complicated and complex, with several different disciplines offering unique methods for providing pain relief. Here, we will discuss some of the most commonly used treatment regimens and what you can expect from them.
Musculoskeletal pain is the sensation of discomfort or pain in structures in the body, affecting bones, muscles, ligaments, tendons, and nerves. Pain symptoms range from mild to severe and can be acute or chronic in nature. Musculoskeletal pain can be local, affecting only a small area of the body, or it can be diffuse with pain symptoms affecting a widespread area.
Lower-back pain is the most common type of musculoskeletal pain, but the causes of the condition can be quite varied. Wear and tear, trauma, or even prolonged immobilization can cause musculoskeletal pain.
Musculoskeletal pain is common in older individuals, but the exact prevalence is unknown. Previous studies have suggested that about 50 percent of individuals 60 and older experience some sort of musculoskeletal pain. It is estimated that 45 to 80 percent of seniors living in nursing homes suffer from musculoskeletal pain; about half use analgesics to help them cope.
However, other reports have stated that the percentage of elderly individuals suffering from pain may be as high as 90 percent within the span of a month, and that musculoskeletal pain represents a major public-health issue as treatment costs can approach $100.0 billion annually.
Studies have found an age-related increase in the prevalence of chronic pain at least until a person reaches their 70s. Approximately 57 percent of older adults report experiencing pain for one or more years compared to less than 45 percent of younger people. Additionally, 40 percent of those found to have pain on initial assessment reported worsening or severe pain during follow-up assessments two to six months later.
Health-care professionals have been ineffective in assessing and treating pain in older adults. This is partly because much of the research done on the subject has not focused on this population, despite their relatively high prevalence of chronic pain. Improvement in this domain will come in the form of better knowledge and skills related to pain assessment in older adults.
Another issue is that older adults may not openly report pain symptoms, and doctors and nurses may not feel inclined to inquire about them without reason. This may be due to age-related attitudes, such as viewing pain as an expected consequence of the aging process. Also, seniors may not report pain as they may not want to be a burden on their families and caregivers.
Those affected by musculoskeletal pain are often caught in a vicious cycle of disuse and inactivity, which further leads to a reduction in their overall function. This inability to perform normal activities often leads to negative psychological effects and a decreased quality of life. Known consequences of poorly managed chronic musculoskeletal pain include:
Older adults may be particularly susceptible to these additional consequences of poorly managed chronic musculoskeletal pain. Several of these consequences in older adults can make therapy and assessment difficult.
By far, the major cause of death and hospitalization amongst older adults are falls. An association between chronic musculoskeletal pain and falls was previously documented by a study that reported that those who had chronic pain had higher rates of falls during follow-up assessments compared to those who were pain-free.
The use of common analgesics is the preferred treatment for chronic pain sufferers. This often includes the likes of paracetamol and/or non-steroidal anti-inflammatory drugs (NSAIDs). They are designed to reduce pain and swelling. However, long-term use of NSAIDs may lead to liver damage and even increase the risk of heart attacks. NSAIDs can also be found in topical solutions, and in this form they don’t pose as much of a risk as they do in oral formats.
Opioids are highly potent analgesic medications, with most doctors debating whether they are appropriate for treating chronic pain. However, there are weaker opioids available, such as codeine and dihydrocodeine, which are known to be effective in managing moderate pain, especially when combined with the medications mentioned above. Opioids are often viewed as a last resort; they are used only after other established therapies have failed.
It is important to note that drug distribution changes as a person gets older. This means the organs normally relied upon to clear the drug from the body may not do so adequately. This may lead to the drug staying in the older patient’s system much longer, increasing the risk of overdose.
Adjunctive therapy should also be considered in pharmacological therapy for pain. This is because chronic musculoskeletal pain can often lead to referred pain (pain traveling to other parts of the body), neuropathic pain (nerve pain that waxes and wanes), and muscle spasms. Adjunctive therapy can include the use of anticonvulsants, antidepressants, or muscle relaxants. While this may have additional benefits, adding more medications may introduce more side effects.
Thermal agents: This includes the use of heating agents such as hot packs, warm hydrotherapy, paraffin, infrared light, short-wave diathermy, and ultrasound. Thermal agents help to increase blood flow, membrane permeability, tissue extensibility, and joint range of motion, all of which can decrease pain. The use of thermal agents hasn’t been studied extensively in the older population as they are often considered forms of self-therapy. Acetaminophen, regular exercise, prayer, and heat and cold were the most frequently used pain-management strategies by community-dwelling adults, as reported by one study. Another study found that the use of hyperbaric CO2 cryotherapy in older adults reduced musculoskeletal pain significantly after only four sessions and was considered an innovative tool for achieving pain relief in older adults.
Manual therapy: This includes joint mobilization and manipulation to aid in pain relief. However, there is very little evidence supporting this form of therapy. One study, however, found that manual therapy is more effective than exercise for those with acute and chronic hip osteoarthritis pain. But the researchers of the study concluded that since they had a relatively small number of patients to work with, the results of the study are still inconclusive with regards to the benefits of manual therapy.
Protective and supportive devices: These help to decrease pain and increase function for patients with joint instability or malalignment. Such devices include the recently introduced Kinesio taping methods that help increase blood circulation, decrease pain, and provide relaxation for fascia, tendons, and muscles. Other devices include impact absorbing shoes, wheel chairs, canes, and crutches.
Transcutaneous electrical nerve stimulation (TENS): This form of therapy appears to be most effective for post-surgical pain. However, studies investigating the differences between TENS and active treatments have found no disparities in terms of pain management.
Cognitive behavioral therapy: This includes the modulation of thoughts, self-statements, or evaluations about the pain and beliefs, interpretations, or attributions regarding the patient’s condition. Cognitive behavioral therapy is well-recognized as being a supporting intervention for chronic musculoskeletal pain caused by conditions like rheumatoid arthritis, osteoarthritis, fibromyalgia, and lower-back pain.
Mind-body therapies: These focus on the interactions between the brain, mind, body, and behavior. They aim to demonstrate how emotional, mental, social, spiritual, and behavioral factors can be used to affect health. Techniques emphasize self-knowledge and self-care. Therapies such as tai chi, yoga, hypnosis, and progressive muscle relaxation have been found to be significantly associated with pain reduction in older adults in several studies.
Biologically based therapies: These involve supporting a person’s normal diet with additional extracts, nutrients, herbs, and/or certain foods. Examples include the use of glucosamine sulfate and chondroitin sulfate by older adults for the treatment of osteoarthritis. These supplements are known components of the extracellular matrix and articular cartilage and they help support joints.
Exercise can be a great non-pharmaceutical approach for chronic musculoskeletal pain management. Physical activity helps to strengthen muscles and reduce weight that would otherwise put more stress on your joints. Musculoskeletal exercises can be especially beneficial in older adults, helping to reduce the risk of falls and subsequent injury. Aerobic exercise, water-based (aquatic) and land-based exercises, aerobic walking, quadriceps strengthening, and resistance exercise can all be great choices for managing musculoskeletal pain.
This form of exercise is usually part of the warm-up and cool-down periods. It involves static stretching, which can be modified when there is a particular area of pain or inflammation. It should be noted that painful joints should not be overstretched. The use of thermal agents can help provide joint relaxation and reduce pain. Older adults may encounter limitations when attempting to perform stretches, but they should still perform them to the best of their ability while increasing the level of stretching as time goes on. Stretching exercises are recommended at least three times per week, or daily if the pain and stiffness are minimal.
Aerobics aim to improve strength and proprioception (awareness of the position of the body), both of which help to reduce pain in osteoarthritis patients. Examples of aerobic exercise include bicycling, walking, dancing, aquatic exercises such as swimming, walking the dog, or playing golf. However, before performing any type of aerobic exercise, it is important for the individual to take into account their own limitations with regards to joint stability, personal ability, and endurance levels. Previous studies have found that regular aerobic exercise in physically active seniors was associated with about 25 percent less chronic musculoskeletal pain when compared to those with sedentary lifestyles.
Both high- and low-intensity strength training can reduce pain. Previous studies have found that progressive resistance training resulted in a modest reduction in pain. However, it has also been reported that there was no significant difference in pain reduction between progressive resistance training, aerobics, and flexibility training. Strength training can be a good choice if patients want to target certain muscle groups.
Tai chi is practiced all over the world for both its defense training and health benefits. While a multitude of training forms exist, it is well-known for being composed of very slow and rhythmic movements, allowing older people to perform them with relative ease. This practice promotes flexibility and whole-body coordination. Previous studies have shown that tai chi can be great for improving balance control, which is highly beneficial for the elderly since this reduces the likelihood of falls.
This is a good option for treating musculoskeletal pain as water is considered a safe environment—its warm temperature can provide some relief from painful muscles and joints. The buoyancy of water reduces the impact or compressive forces on the joints, which makes aquatic exercise especially ideal for older adults with osteoarthritis. Aquatic exercise can also be used to strengthen muscles by using water resistance.
This is perhaps the easiest form of exercise that is both accessible and fun, assuming you don’t suffer from any severe disability. Several studies have found that simply walking is associated with significant improvements in the outcome of musculoskeletal pain.
This is a division of medicine that caters almost exclusively to treatment for musculoskeletal pain. Chiropractors use techniques such as osteopathic manipulation as well as hands-on spinal realignments. It is considered safe and effective for ailments such as back pain, neck pain, or sciatica. Studies have been done comparing chiropractic treatment with more conventional medical care for musculoskeletal pain issues affecting adults of various ages. If done currently, chiropractic treatment can be a viable choice for
pain relief and speedy recovery.
While pharmacotherapy such as NSAIDs and opioids can help reduce pain in the short term, their negative effects in the long term can lead to additional, unanticipated health consequences. Exercise and psychosocial intervention have been proven to be effective in improving and relieving musculoskeletal pain without any unwanted side effects. A balanced combination of these two interventions would be ideal and should be guided by a trained medical professional.