Pain Perception: Young vs. Old
In this blog post, I'd like to explore the contrasting experiences of pain and how our perceptions of it may change as we age. I believe this perspective will resonate with individuals of my generation, who have traversed the journey of youthful resilience to the challenges of ageing. It is not meant to be a review on the various aspects of neuroscience behind the complexity of persistent pain, more a journey of how easy it is to become stuck in unhelpful ways of thinking. Feel free to share your thoughts in the comments below.
Pain Perceived as a Youngster
Most of us can vividly( or not as the case maybe!) recall the days of our youth when we picked up injuries while engaging in various physical activities. Take, for instance, a pulled hamstring. I remember the searing pain at the time, but miraculously, about four weeks later, I was back on the rugby field, sprinting as if nothing had happened. In those carefree days, I, like many of my peers, believed in our youthful invincibility. Seeking medical attention wasn't on our radar, and somehow, most injuries just seemed to heal by themselves. There was no sense of angst or worry.
There seemed to be a predictable outcome – recovery. So, a decade later, when I experienced the same hamstring injury again, I had a sense of what to expect. I anticipated a four-to-five-week recovery period, and that's precisely what happened. My expectations were build on past experience and similar experiences of my peers.
Pain Perceived as an Older Person
Over the many years of working with older individuals, aged 50 and above, as a therapist, I've noticed a consistent trend. It goes something like this:
An individual injures a joint/muscle but doesn't seek physiotherapy.
The pain lingers, leading to reduced activity levels.
Frustration sets in as attempts to regain pre-injury activity levels repeatedly fail,usually due to pain, which in many instances this is now equated to increasing tissue damage.
Crucially in this period( experience of pain for more than 3 months), we shift from acute pain to persistent pain.
Opinions from others reinforce the belief that this is the inevitable consequence of ageing.
Indeed when you were a child a family member might have suffered from disabling arthritis, for example. 'So maybe thats what we have got to expect.'
Your peer group also experience similar episodes of pain.
Each morning you get out of bed you expect to have your pain.
Enough if enough, you need to find out what is going on!!! A visit to the GP is booked, and results are in:-
"The spine is crumbling."
"It's bone on bone."
"Degeneration and instability."
"Torn cartilage."
"Slipped disc".
"Wear and tear."
"What do you expect at your age?"
"Physiotherapy won't help."
How helpful is the language above in helping a patient manage their pain?
So one day you wake up with pain, and you have one or all of the above? But the day before you had none of the above? As you will see from the evidence below all the above are a normal part of the aging process. People without any pain whatsoever, can have one of the above or all of the above. Nine out of ten people need a plan not a scan!
Misconceptions about Imaging/scans etc and Pain:
Studies have shown that the extent of tissue damage observed in scans and X-rays does not necessarily correlate with the level of pain experienced:
An MRI study of healthy adults found that 98% without neck pain had degenerative changes in their cervical disks.
Lumbar disk degeneration is present in 40% of people younger than 30 and observed in 90% of those aged 50-55, unrelated to the levels of pain experienced.
Healthy 20–22-year-olds without back pain had at least one degenerated disk, and 25% had a bulging disk.
X-rays showed that almost 85% of adults with no knee pain have arthritis in the knee, and 48% of healthy basketball players have cartilage/meniscal damage on MRIs.
An MRI study of adults without shoulder pain showed that 20% have partial rotator cuff injuries, 45% have a full-thickness tear, and 50% of adults over 60 had rotator cuff tears.
Changing movement patterns can be relatively straightforward, but altering beliefs around pain can be a significant stumbling block. The road to recovery often begins with challenging these unhelpful beliefs.
In summary, tissue damage and the extent revealed in scans do not reliably correspond to the level of pain a person experiences, particularly when pain becomes persistent.
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