Pain Assessment and Management

Importance of assessment.

Chances are that over 50s will have some aches and pains. Before we embark on a program or regime we must achieve proper assessment. I would always recommend that you seek a professional assessment if,

  1. Your pain has been long term and is or has been chronic.
  2. The pain affects your daily life, i.e sleeping, working, movement in general
  3. Is your pain constant?
  4. If you have any other symptoms, such as nausea/ vomiting, constipation, etc.
  5. You have any other underlying health issues or are overweight.
  6. Where, is the Pain.

There is an acronym for pain assessment W.I.L.D.A

W: Words to describe your pain; Dull, throbbing, stabbing, burning, etc. I; Intensity, 0 – 10. L; Location. D; Duration, Is the pain constant or does it come and go? A; Aggravating and Alleviating factors, What makes it feel worse or better.


How to relieve the pain

If you’re are given the all-clear by a medical professional to exercise, then you will need to build your life around your new regime, . In general, initially, you will need to exercise at least 20 minutes a day, three days a week.

The level of exercise depends on the level of pain but in an ideal world once we have alleviated the pain we should be aiming to work out 5 days a week for at least 20 minutes a day.


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I will give an example, I have 2 prolapsed discs lower 4/5. I can quite happily lift a bag of cement or even my bodyweight but if I move slightly wrong or even pick a pin-up from the floor, my back can go into spasm.  SOUND FAMILIAR? When this happens I will hit the floor and exercise every 3 / 4 hours until the pain subsides.

I would add that it is incredibly rare for me to take a pain killer to alleviate the symptoms, I prefer to work through it!

One of the luxuries I allow myself purely for maintenance purposes is a deep tissue body massage once a month. For me, Thai Massage works the best!

Exercise systems such as Yoga and Pilates are excellent for the management of joint or muscle pain and a lot of my regime is built around these systems. One of the most important areas for back pain, in particular, is your core, I refer to all the muscles surrounding your spine and in particular your stomach.

Every pain syndrome has an inflammatory profile consisting of the inflammatory mediators that are present in the pain syndrome. The inflammatory profile may have variations from one person to another and may have variations in the same person at different times. The key to the treatment of Pain Syndromes is an understanding of their inflammatory profile.


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One of the keys is to fight the inflammation. How can we do this without anti-inflammatory drugs?

Heat treatment, especially for back pain, is effective,  One economical way of providing dry heat to the affected area, is to get an old sock and fill it with rice. Tie off the opening or sew it shut, pop it in the microwave for a minute to a minute and a half and apply to the area where needed. I prefer dry heat on my back and have found to be more effective than let’s say a hot water bottle. If you are fortunate enough to have a heat lamp then this is also a good method.

At the end of the day, what we are trying to achieve is the relaxation of the muscles in the back.  Please remember for inflammation / swelling ice is recommended but for muscle spasm heat.

In the old days before much understanding of the causes of back pain, they would say lie on the floor! This does work but I would mix this with some gentle stretching.

Below is a report on back pain from the W.H.O:

Low back pain (LBP) is one of the most prevalent conditions worldwide, with the results of the Global Burden of Disease (GBD) study in 2010 reporting a global point prevalence of 9.4%. The World Health Organisation further reported that up to 70% of the population in industrialized countries will experience non-specific LBP (i.e. without a confirmed pathoanatomical cause as opposed to specific LBP that may be linked to intervertebral disc damage, such as herniation or fractures, vertebral infections, cancer including bony metastases and spondylarthritis in their lifetime; however, there is increasing evidence showing that LBP prevalence is also increasing in the developing world. The prevalence of LBP seems to increase with age, with the peak being between the ages of 35 and 55 years. LBP has a strong tendency to become chronic and is among the most commonly reported localisations for chronic pain issues, with some reports showing a global prevalence of almost 20% in people aged between 20 and 59 years. The results of the Austrian Health Interview Study showed that 25% of respondents in this nationally representative survey reported chronic pain in any body site and the 1-year prevalence of chronic LBP was 10% of the adult population. Moreover, studies of epidemiological monitoring of LBP in the USA have reported a rising trend across age groups and in both men and women.

A broad variety of factors are involved in the development of LBP and often limited effects in treatment lead to LBP being associated with very many detrimental health outcomes, such as disability and overall limited mobility, poorer self-reported health, lower quality of life and depression as well as more workplace absenteeism. These issues as well as the growing prevalence put LBP as a major public health problem, associated with increasing costs for social systems. Results of a recent Austrian study looking into societal costs linked to chronic pain issues reported overall annual costs of 10,191 Euros per patient, with inpatient rehabilitation, and out-of-pocket costs being identified as the two most expensive costs factors, the latter being also the conclusion of a 2008 Austrian study.


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Patients with LBP often report issues with routine functioning and participating in daily activities, with impairments in interpersonal relations and community life being especially important for patients with LBP. An Austrian study reported that in patients with chronic LBP the strongest association with health satisfaction was not needing medical treatment to function in daily life. In men with chronic LBP additionally, satisfaction with sex life and satisfaction with work capacity strongly determined health satisfaction, while in women such a determining factor was satisfaction with living conditions. This suggests that functional independence, workability, and sexual function are essential and probably the most important health outcomes of people with LBP in their perception. Aging, however, may also affect personal physical and psychological resources, changing the importance of these functions during the life span.

With the apparent growing public health issues connected to LBP and the growing number of publications, often with conflicting results, this study aimed to summarise the current knowledge on functional performance in people with LBP through its influence on activities of daily living, workability and sexual function in a narrative review. Furthermore, it was the aim to reveal and discuss potential factors mediating the association between LBP and those three measures of everyday performance.

The connection between lower back pain and knee pain from a Japanese study:

Objective

To test the hypothesis that the interaction between low back pain (LBP) and knee pain intensity contributes to the disability level of individuals with knee Osteoarthritis.

Results

A total of 260 participants (age, 48–88 years; 77.7% of women) were included. Of them, 151 (58.1%) had LBP. The LBP–knee pain interaction was significantly associated with a disability after the adjustment for covariates. A posthoc subgroup analysis revealed that the relationship between knee pain intensity and disability level was higher in individuals with LBP


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Conclusions:

LBP interacts with knee pain intensity and contributes to the disability level in individuals with knee OA. Coexisting LBP and knee pain had a stronger impact on disability level than LBP or knee pain alone. These findings highlight the potential deteriorative effects of the LBP–knee interaction on disability. Maximal treatment effects for disability might be achieved when LBP and knee pain are targeted simultaneously, rather than separately.