Pain-Free Aging: Best Practices for Prevention and Wholistic Treatment of PainDr. Heather Tick, MD March 1, 2008
As the Baby Boomers navigate middle age, there is a new energetic definition to aging. There is an acceptance of older faces peering at us from billboards and more advertising is geared towards the generation that has always been a defining force for the marketplace. But there is still a struggle in this generation with the implications of aging. For some people it is only acceptable to age if they can still act as though they’re 30 years old. Those who aim for eternal youth often throw caution to the wind as they pursue unhealthy habits for as long as they can. For these people aging may seem shocking.
The process is easier for those who acknowledge that they will age but want to do it gracefully. Age will not affect every person in the same way. One of the key factors in pain-free aging is to accept the aging process of your own body. Some assume that aging means we will be in more pain: this is not necessarily the case.
Throughout life there is a balance between the injury and healing rates of our tissues. Regardless of age, whenever the injury rate exceeds the healing rate, there will be pain and dysfunction. As we get older, our natural healing rates decline for a variety of reasons. Therefore we must adjust our activities to reduce the injuries or improve our self-care methods to increase our healing rates.
Think of it like a bank account. If you eat well, take your supplements, tone and stretch your muscles, are involved in fulfilling relationships, and sleep soundly for at least 7 hours a night, you are putting money in the bank. If you exercise too vigorously, abuse alcohol, eat over-processed foods, feel socially isolated, and don’t get restorative sleep, you are spending money that you could be saving.
Here are some issues that need attention:
Posture, alignment and flexibility – Posture and alignment are important from when we first learn to walk. As we age there is more urgency to have optimal posture and alignment since some changes may become irreversible during these years. For a variety of reasons, such as osteoporosis, prior injuries, and reduced muscle tone, it is important to work with a professional such as a chiropractor, physical therapist, yoga or pilates instructor.
Not everyone is meant to look like a pretzel in yoga class. Each of us needs to work for well-toned muscles and a level of flexibility that is comfortable for us. I have seen people in their 70’s and 80’s who had been told for years that the limited mobility of their neck is to be expected because of their age. After x-rays revealed mild to moderate wear and tear arthritis, I treated these people and helped them to achieve 75-100 percent of the normal range of motion for the neck.
Exercise – It is important to find the right types of exercise for your body. If you injure yourself frequently when you run then your body is giving you a message: it is not suited to that activity. There is a recent study showing that women runners develop osteoarthritis of their joints earlier than other women. Those who over-exercise increase wear and tear, and may not be giving their bodies enough time to heal.
Diet – Reduce sugar, simple carbohydrates, and red meat, and increase vegetables, fruit, and complex carbohydrates like whole grains, beans, lentils, and legumes. This makes your body less acidic and less inflamed and can reduce pain.
Type II Diabetes is a common cause of pain. In diabetes the tiny blood vessels called capillaries become damaged and this can affect the health of the nerves, making them painful. Diabetics in general heal more slowly due to fluctuations in blood sugar. Reduce your risk of diabetes by controlling your weight with diet and exercise.
Excess weight causes increased pressure on all the weight bearing joints and accelerates wear and tear. Sometimes the pain in joints is not caused by abnormal joints but rather the excessive job they are expected to do. If you are overweight, reducing to an optimal weight will reduce joint pains.
Antacids (prescription and OTC) – reduce stomach acid which can affect the absorption of some nutrients. They are often prescribed for stomach pain, ulcers, gastritis, and acid reflux. For short term of treatment of the above conditions these medications are justified, however these drugs have never been tested for long-term health effects (over years). Most of these conditions are due to improper diet. Find the way your digestive tract likes to be fed in order to eliminate the need for these drugs in the long run.
Anti-Aging Supplements – Vitamin D is the sunshine vitamin, yet we have been covering up to protect ourselves from the sun. The only way to know if you are getting enough Vitamin D is to have your Vitamin D 25OH level checked by a doctor and make sure the level is in the optimal range (100-150 nMol/L). Studies show that adequate Vitamin D improves bone density, maintains a healthy immune system, reduces autoimmune disorders, improves muscle strength, decreases pain, and has a role in brain function and reducing cancer rates. Use supplements to bring your Vitamin D level into the optimal range and have the level re-checked two months later to confirm that you are in the optimal range.
Vitamin B12 requires stomach acid for the absorption process. Research is showing that even if you have normal blood levels of B12 you may still have inadequate levels inside your cells. As we age, our stomach acid naturally declines and so it gets harder to extract enough B12 from our food. Many people also take medications designed to reduce stomach acid. Vitamin B12 given daily by injection has been shown to reduce pain and help people reduce the use of painkillers. You can also get Vitamin B12 through tablets that dissolve under your tongue (sublingual). More research is needed on this vitamin, but there are no known problems with taking too much. I have many patients taking 5000mcg sublingual B12 daily.
Adequate levels of Omega 3 oils have been shown to reduce pain, inflammation and even the risk of cancer and heart disease. High doses are required so make sure that the brand you use has been highly purified to remove contaminants like mercury. The studies on pain have found 3000-4000mg of DHA and EPA to be effective. (DHA and EPA make up about 50% of the contents of good quality capsules.)
Interesting Nutritional Facts:
There is still the need for more research on many of the nutrients. Humans are one of only a few mammals that cannot manufacture Vitamin C. For example, a 4 pound rat makes around 10 grams (10,000 mg) of Vitamin C daily and manufactures 10 times that amount when under stress. Yet the recommended daily allowance for a human is under 100 mg.
Studies have shown that when we exercise we sweat out not just salt and water, but other minerals as well. So it is important to replenish with a balanced multi-mineral after exercise.
Low fat diets have become very popular as we focus our attention on cholesterol and triglycerides. But these fats are only part of the risk picture for cardiovascular disease – inflammation is a major factor in the development of heart disease. Omega 3 oils protect the heart and the Omega 3/Omega 6 balance may also be important for bowel function and the maintenance of bone density.
Hormone Balance – Hypothyroidism (underactive thyroid) is more common as we age. Other hormonal changes that take place through aging are very complex, involving estrogen, progesterone, testosterone, growth hormone, DHEA, and cortisol. Consulting a physician about a detailed assessment of your hormone balance may suggest some interventions that can improve healing.
Medications – As a “quick fix” society, we turn to medications very readily. For the most part they can be very helpful in the short term but it is essential to remember that:
1) Most medications DO NOT treat the problem; they only mask the symptoms.
2) They all have the potential to cause harmful side effects.
3) Always be certain that the “cure” is not more harmful than the “disease”.
(This does not apply to medications that you are taking for diseases that can kill you, like diabetes, high blood pressure, and heart disease. Problems arise when healthy people take drugs for years to deal with conditions which should be corrected by lifestyle choices.)
Drugs used for pain – Some over-the-counter (OTC) drugs commonly used to treat pain are acetaminophen and the non-steroidal anti-inflammatories (NSAIDs): ibuprofen or aspirin. It is often assumed that because a drug can be purchased without a prescription, that it must be safe. The lethal dose and the therapeutic dose of acetaminophen are very close to each other. This drug can damage the liver with large doses and with long term use of moderate doses. The NSAIDs have been implicated in chronic renal failure and acute bleeding from the gut.
Opioids have been used for non-cancer pain and require great care. There are special receptors in the brain and body that these drugs attach to. Because of the way these drugs affect the receptors, people develop tolerance to these medications and then require more drug for the same effect. This is not the same as addiction. Care must be used with prescribing these drugs.
Drugs taken for other reasons which can cause pain – Cholesterol lowering drugs called statins can cause muscle pain. If you can control your cholesterol through exercise, weight reduction, and diet, you may be able to do without these drugs. Consult your healthcare professional about any changes you plan to make. Pay attention to the current literature – these drugs may not be as effective as once thought.
The FDA has recently issued a warning about drugs called Bisphosphonates and severe musculoskeletal pain. These drugs are used mainly for osteoporosis.
Mind-body connection – Stay youthful, stay useful. Find meaning in your life. Find challenges that give you a sense of accomplishment and help to exercise your mind. Distraction is a useful technique for dealing with pain. The new field called psychoneuroimmunology, or mind -body medicine, has shown that stress can delay healing, impair immune function and be involved in the development of pain. Recent studies on emotion indicate that the way we deal with anger can adversely affect our health and that our supportive relationships can protect us. This research has not focused specifically on pain but it is likely that further study will show effects on pain.
When we are stressed our adrenal glands secrete epinephrine which promotes inflammation. Therefore meditation, which rests the adrenal glands, may be the most potent anti-inflammatory of all.
Intramuscular Stimulation for Pain Relief
IMS involves the placement of extra long acupuncture needles into various injured and shortened parts of muscles, called trigger points (TP’s). There is an electrical impulse released from the muscle with needle insertion. The muscle may flinch or ‘jump’, or it may slowly cramp and then relax. In either case the result is muscle lengthening which reduces pain by addressing the root cause of the problem – the shortened muscle.
When being treated with traditional acupuncture people often do not feel the needle insertion. The needles are left in place for approximately 20-30 minutes. With IMS the needle is being placed into the tender parts of the muscle and there is a deep ache within the muscle at most points that are properly treated. Patients can generally feel the release of the muscles immediately as the needles are inserted and left in place only until the muscle releases.
The result is an immediate improvement and a change in the anatomical structure. Typical conditions such as Repetitive Strain Injuries, Sciatica, Piriformis Syndrome, and neck pain disappear with only a few treatments…
Getting older does not mean we have to suffer more pain. If we are wise, make healthy choices, and care for our bodies as well as we care for the machines in our lives, we can live comfortably for our allotted years. First we must get over the psychic pain of getting older and then listen to our body and soul as it goes through its unique path to getting older. As my father used to say, “getting old has its problems but it beats the alternative.”