Back pain is a common complaint in seniors, which can result in considerable pain and disability. For this reason, older adults aged 65 and above form part of the age groups that visit healthcare facilities for back pain problems on a regular basis. Studies have shown that the prevalence of this health condition rises from teenage years through to individuals aged 60 before declining.
Researchers are convinced that the trend is largely due to occupational exposure among working-age adults. In addition, they link the rise to age-related changes associated with stoicism and pain perception. The degeneration of spinal joints is a major factor that causes pain for senior citizens. Spinal stenosis and osteoarthritis contribute to the development of pain.
However, most of the causes of back pain are self-limiting and non-specific. Aging leads to the development of various spinal pathologies, such as lumbar spinal stenosis, tumors, spinal infection and osteoporotic vertebral fractures. Many factors affect the prognosis and management of these disorders. The factors include physical inactivity, dementia, spinal degeneration and age-related processing of pain.
Early diagnosis and treatment of back pain is crucial because severe cases of the condition can lead to functional disability and poor treatment outcomes. Studies have shown that the condition is usually under-treated. Up to 50 percent of analgesics prescribed by healthcare professionals are given to patients at sub-optimal doses. On the other hand, approximately 25 percent of older back pain sufferers are not given analgesics.
Experts say senior citizens must be given analgesics as a standing dose rather than when deemed necessary. This is aimed at achieving a steady concentration of analgesic serum. Doing so makes it easier to ensure continuous pain relief, particularly for sufferers with cognitive impairment.
Spinal anatomy is an intricate structure consisting of nerve roots, tendons, muscles, bones, nerves and flexible ligaments. Nerve roots are designed to transmit messages. The spine provides shock absorption capacity and enables the body to handle jolts and stress associated with certain types of movements. Flexibility of the structure makes it easier to bend and twist while bones, as well as supportive muscles, enable humans to stand upright.
The middle or upper back (thoracic spine) is connected to 12 vertebral bodies, which are located in the upper back. This structure provides protection for vital organs and structural support for the entire body. A degenerated thoracic or herniated disc can trigger upper back pain. It is also possible that the pain can be caused by spasm or joint dysfunction in the large upper back muscles.
The lower back is more susceptible to injury and pain because it bears the most load yet it has the least structural support. In most cases, lower back pain is triggered by muscle strain, which can cause severe pain. The bottom segments of the lower back handle motion more than four other segments that make up this part of the body. The pain or sciatica associated with this region typically radiates down the sciatic nerve and makes its way to the legs. Sciatica symptoms differ based on the affected nerve.
Causes of back pain
The majority of back pain sufferers have no definitive pathology, such as inflammation or fracture. As a result, these cases are diagnosed as non-specific back pain. The pain is triggered by a variety of factors, including time of the day, physical activity and posture. This type of pain has the capacity to originate from multiple sources. Many older adults experience pain due to disc degeneration.
Facet joint pain may appear in the form of localized back pain coupled with pain that extends to the thigh area. The effect is usually felt while walking and aggravated by different types of motion. These include rotation, trunk extension, and ipsilateral lateral flexion. On the other hand, lumbar degenerative spondylolisthesis typically affects women aged 60 and older. The condition is also associated with facet hypertrophy.
Senior citizens affected by spinal stenosis, pain and neurological deficits may have degenerative spondylolisthesis. This is coupled with the thickening of ligamentum flavum and facet hypertrophy.
Research has shown that non-specific back pain can occur on structures other than the lumbar spine. A significant number of seniors show symptoms similar to sacroiliac joint pain and myofascial pain. Tell-tale signs of sacroiliac joint pain closely resemble facet joint disorders. Both complications entail localized pain with or without pain that extends to the thigh area. Suffering can be alleviated by lying on the bed.
Myofascial pain is characterized by muscle tightness and tenderness, which causes resistance to passive stretching. Movement may induce referred pain on palpation. This condition is common among seniors and it originates in piriformis or lumbar muscles.
Spinal infection is another potential cause of spinal pain. Vertebral osteomyelitis (VO) is a good example of infections that lead to severe pain. The disease is life threatening and its prevalence in older people has been increasing in recent years due to the expanding aging population. The pathogenic bacteria can be transmitted hematogenously from the source to another area.
Staphylococcus aureus is one of the pathogens linked to VO infections. Seniors may also face tubercular vertebral osteomyelitis in the event that they contract tuberculosis at a young age. Mycobacterium tuberculosis is known to affect and remain in the vertebral bone. The situation worsens due to age-related deterioration of immunity.
Postmenopausal women are more likely to suffer osteoporotic fracture, which causes considerable pain. The prevalence of vertebral compression fracture rises with age. Reports show that prevalence rates can reach as high as 40 percent for postmenopausal women over the age of 80. Patients affected by this condition generally experience more disability. The situation is compounded by incorrect diagnosis since the majority of seniors are convinced that bone and joint pain are a normal part of the aging process.
For this reason, healthcare practitioners focus on examining older patients with acute onset of localized back pain. The problem may show signs of paraspinal muscle spasm. Some of the risk factors for vertebral fractures identified by a recent study include corticosteroid use, aging, and trauma. Compression fractures typically originate at the thoracolumbar region and they may lead to radiculopathy.
Although age is a major factor that contributes to back pain, there are additional factors that perpetuate the problem in senior citizens. Taking necessary precautions helps manage the complications. Older adults with a poor self-perceived health status tend to suffer from severe cases of lower and upper back pain. This was demonstrated in a study involving seniors aged between 70 and 102. As such, it is important to maintain a positive outlook of one’s health.
Vigorous levels of physical activity also heighten the potential of suffering from back pain. This applies to all age groups. Physicians are trained to evaluate the physical activities of older patients who experience back pain with the aim to provide relevant recommendations.
On the other hand, smoking significantly increases the risk of experiencing spinal pain. Scientists are convinced that smokers have a different perception of pain when compared to non-smokers.
Smokers face an increased risk of developing the problem due to the degenerative effects in spinal structures. Smoking affects intervertebral discs and other spinal structures. It is common for smokers to experience neuropathic back pain resulting from the compression of neural structures by the degenerative changes.
A number of social factors have been shown to affect the genesis and persistence of spinal pain. These include social stressors like poor living conditions, which may have a negative impact on emotion and psychology.
Depression has the capacity to induce this type of pain. This typically affects senior citizens with limited social support structures. Researchers have also noted that older adults living in long-term care facilities depend on the attentiveness and responsiveness of caregivers when it comes to recovery.
Occupational exposures can contribute to spinal pain in retired seniors. Individuals who have been exposed to whole-body vibrations and excessive lifting, stooping, bending and twisting face increased risk.
Treatment options for spinal pain
The American Geriatrics Society provides guidelines on how medical practitioners can manage nonmalignant pain when dealing with geriatric patients. The entity recommends that clinicians prescribe analgesics like acetaminophen for patients suffering from chronic spinal pain. The medication should be prescribed as a standing dose to ensure that patients have a steady concentration of analgesic in their system.
Caution must be exercised when prescribing Tramadol to patients with the risk of seizure. The same applies to anyone taking drugs like neuroleptics and tricyclics designed to lower seizure threshold.
Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for patients who do not respond positively to acetaminophen. In such cases, NSAIDs can be prescribed as an adjunct therapy. However, senior citizens suffering from peptic ulcers and gastrointestinal bleeding should be given non-acetylated salicylates to avoid stomach upsets.
Physicians are expected to tailor doses to suit individual needs since there is no ideal does for opioid medications. Opting for two or more pain medications reduces the potential for experiencing side effects. This approach eliminates the need to prescribe high doses of a single drug, which elevates risk levels.