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Dr Rodrigo Megale is a Brazilian physician specialising in geriatrics , graduated from Medical School (UFMG) in 2002, with advanced training in Internal Medicine (2002-2004) followed by Geriatrics (2004-2006) through accredited residency programs (MEC). He has Masters Degree in Public Health (Epidemiology) from Fiocruz and is, currently, undertaking his PhD in The University of Sydney - Medical School.

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It is usual among older adults to think that musculoskeletal pain is a benign symptom related to the “wear and tear” of ageing. If you are in your 70s or 80s, you probably have already heard from health professionals that chronic pain is something that you should get used to, and that it is a very common age-related condition. I, myself, have said that to many of my patients. It turns out that having chronic or persistent musculoskeletal pain is not as benign as it was thought to be.
Several studies have shown an association between chronic pain and frailty, a pre-disability condition, clinically characterised by weight loss, exhaustion, weakness, slowness and low physical activity. Those who have been experiencing bothersome joint or low back pain might be worried at this moment; however, there is no reason for that. If your pain is not interfering in your daily living activities, and your doctor has already assessed it in order to rule out any serious condition, there are some tips that can help you cope with your symptoms.

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The first important thing that you need to know about chronic pain is that, in many cases, the source of pain is not only joint inflammation, cartilage damage or disc degeneration/ protrusion. Actually, it seems that our brains play a very important role in this condition. Chronic pain usually involves a problem in the so called “descending inhibitory pathway”, which is part of your body’s pain management system, and it is controlled by your brain. That is probably why some patients report less pain when they are surrounded by loved ones or when they are on a pleasant trip. Our brain is capable of modulating the pain we feel. If you focus on your pain and drive all your attention towards your suffering, your behaviour could probably “enhance” your pain. On the other hand, if you drive your attention away from your suffering and try to focus on positive aspects of your life, there is a reasonable chance of achieving pain improvement.

Another important takeaway from previous studies is that, different from what is expected from acute pain treatment, total pain relief is usually not achieved in patients with chronic pain. Sometimes patients seek for care with unrealistic expectations regarding pain relief, pushing their doctors to prescribe “strong” pain killers, which have also “strong” side effects. The best treatment for chronic pain is still unclear but probably involves more than just the use of pain relieving medications. In chronic pain, “adjuvant” drugs (medication that is primarily used for something other than pain but also have analgesic properties in some painful conditions) and non-pharmacological interventions are critical parts of the treatment. It is common to see patients with chronic pain on anti-depressants or anti-epileptic drugs, even when they do not have any depressive symptoms or have never experienced seizures. It may sound strange but, since your pain has become chronic, it is highly probable that your nervous system has been affected, even if your pain has a clear cause like osteoarthritis or degenerative back conditions. Thus, the pharmacological treatment may be directed to nerves and your brain rather than joints and muscles only. Unfortunately, once the nerves have been affected, it is very difficult to restore their normal function.

Acute musculoskeletal pain is useful as it indicates that something is wrong with our joints or muscles, but chronic musculoskeletal pain, on the other hand, is usually a dysfunctional response and, as previously mentioned, indicates a nervous system problem rather than a joint problem. Although rest may be advisable in cases of acute musculoskeletal pain, there is no excuse to avoid physical activity in cases of chronic pain, as long as you get your doctor’s clearance for it. To wait for a spontaneous pain improvement before taking up exercises is not wise. Actually, several studies have shown that exercise can be one of the best treatments for chronic pain. It is also the best way to prevent the development of frailty, the pre-disability condition mentioned in the beginning of this blog. Exercising is good for the body and mind, and can also be a good way to manage chronic pain on your own.

In summary, chronic pain is not part of normal ageing, and those suffering from chronic musculoskeletal pain can help themselves by: a) seeking a doctor to rule out serious conditions; b) trying to take the focus away from pain (taking up pleasant activities may help you focus your attention away from pain); c) understanding that, as in many chronic conditions, total recovery may not be achieved; d) adding non-pharmacological interventions as part of the treatment (pain killers are not as effective as they are for acute pain management, and adjuvant drugs are associated with many adverse events in older adults); e) choosing an exercise that you enjoy and start doing it as soon as you get your doctor’s clearance.

Remember: some discomfort with exercise is acceptable, and even expected in the beginning. Do not trust only in drugs for pain relief. They are important, but so are your behaviours towards pain. Be proactive in your treatment (but PLEASE, do not start or interrupt any medication after reading this text).

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