Taking it on the hip: Do older people deal with pain better?

What does it mean if younger people report more difficulty coping with pain? Does this mean younger people experience more pain in their lives? Are older people just more stoic? Or have the latest medical advances lowered a generation's pain threshold? A forthcoming study in the journal Pain Medicine, published by the American Academy of Pain Medicine, finds that older people can deal with pain better, even when younger joints, younger muscles and a youthful optimism might suggest otherwise. And though the study found that African American men and women report more pain on average, the same generation gap holds true.

The study took place at the University of Michigan Multidisciplinary Pain Center, using eight years of data from 5,823 patients. Precisely, patients completed a standardized form asking, among other things, the intensity and location of their pain; their sleeping patterns; their alcohol consumption; and their own ability to cope with the pain. Divided only above and below the age of 50, the study incorporated patients with many different chronic pain conditions.

But what does a "chronic pain condition" actually mean? What constitutes pain versus, say, discomfort, irritation or annoyance? According to Dr. Laurie Ferguson, a psychologist and Senior CreakyJoints Affliated Professional, "pain is always a subjective experience. There are some people who make it the centerpiece of their lives and some people who make it a sideshow." In other words, pain may be what we make of it. Citing the existence of pain remedies since the dawn of time, Dr. Mark Young, a pain management specialist, author of Women and Pain: Why it Hurts and What You Can Do and Senior CreakyJoints Affiated Professional, calls pain "the most important disorder." At its most basic level, Dr. Young continues, pain is a "warning system" recognizing that something just isn't right. For this reason, pain "can be a friend and it can be a foe." It is a friend when temporary and alerting. (Remember the old joke: "Doctor, it hurts every time I do this." "So don't do that.") It is a foe when it's chronic and threatens to disrupt a person's way of life.

Dr. Carmen Green of the University of Michigan--co-author of the study, along with Dr. Tamara Baker of the University of South Florida--posits two theories explaining the generation gap. One is age-specific: "younger people, who may be dealing with job and family stress in addition to their pain may experience more negative effects." One is generation-specific: "they may also have different expectations about pain treatment and about experiencing chronic pain at a relatively young age. This is particularly important because the prevalence of chronic pain is increasing."

When weighing these explanations, it is interesting to recall how pain management only became a field of specialization in the 1950's, then gaining momentum with the Hospice movement of the 1970's. Therefore, the question of altered expectations may be an important one; might the prevalence of chronic pain be increasing because doctors are now looking for it and patients are now expecting its treatment? Dr. Ferguson felt the study revealed the new cultural expectation of no pain: "I remember speaking with Rheumatologists who tell me their patients now expect no pain, not less pain."

If anything else, chronic pain seems to be the synthesis of many factors. Reflecting chronic pain's emotional and physical scope, both Dr. Young and Dr. Ferguson use multi-faceted approaches. Dr. Young balances medication and physical therapy with yoga, acupuncture and relaxation therapy. Dr. Ferguson listens to patients express their pain but then seeks to reframe it from a "centerpiece" to a "sideshow". She especially encourages them to continue doing the things they enjoy doing, to continue living life.

Young people, take note.

Article References
Pain Medicine, Vol 6, No. 1, Jan 2005.

"Younger Adults Do Not Appear To Cope as Well With Pain as Their Elders" www.docguide.com, site accessed 2/1/2005

Clark D. 'Total Pain', disciplinary power and the body in the work of Cicely Saunders, 1958-1967. Soc Sci Med 1999 Sep; 49 (6): 727-36.