Movement as Medicine: Reclaiming Your Life from Chronic Pain

Chronic pain is a common ailment that is experienced by people of all ages and includes serious discomfort that requires our full attention.  Chronic pain is an ongoing, often debilitating pain that rarely goes away.

Treating chronic pain in older adults requires a careful, highly individualized approach. Because our bodies change as we age, we must balance effective pain relief with the need to minimize risks, such as drug interactions or falls.

Here is a clinical approach sometimes used for managing your chronic pain, broken down into five key areas:

1. Physical Therapy and Prescribed Movement

From a clinical standpoint, movement is one of the most effective prescriptions I can write for you. When you have conditions like osteoarthritis or chronic lower back pain, it is natural to want to rest. However, prolonged inactivity leads to joint stiffness and muscle atrophy, which ultimately increases your pain

It is good to start with a referral to a physical therapist. They will perform a functional assessment and design a therapeutic exercise program tailored to your current mobility. We will focus on low-impact, joint-sparing activities such as aquatic therapy, stationary cycling, or tai chi. These exercises will improve your joint lubrication, strengthen the muscles supporting your joints, and improve your balance, which is critical for fall prevention

2. Behavioral and Mind-Body Interventions

Pain is processed in the brain, and chronic pain can actually rewire your nervous system to become hyper-reactive. As your doctor, I want to address not just the physical source of your pain, but how your nervous system is interpreting it. I often refer patients to pain psychologists for Cognitive Behavioral Therapy (CBT). CBT is an evidence-based treatment that helps you develop coping strategies to manage pain flare-ups and reduces the anxiety and depression that often accompany chronic pain.

Additionally, you may integrate mindfulness-based stress reduction and deep diaphragmatic breathing into your daily routine. These practices stimulate your parasympathetic nervous system, lowering stress hormones and clinically reducing your perception of pain.

3. Nutritional Optimization and
Sleep Hygiene

Your diet and sleep patterns directly impact your body's inflammatory response. Clinically, systemic inflammation exacerbates conditions like rheumatoid arthritis and neuropathic pain. You may adopt an anti-inflammatory diet, such as the Mediterranean diet, which is rich in omega-3 fatty acids and antioxidants. You should also review your sleep hygiene. Chronic pain disrupts sleep architecture, and poor sleep lowers your pain threshold

You should also maintain a strict sleep-wake cycle, optimizing your bedroom environment for sleep, and avoiding stimulants late in the day. If sleep disturbances persist, you may need to evaluate your likelihood of conditions like sleep apnea, which are common in older adults and can worsen pain outcomes.

4. Pharmacological Management and Topical Agents

When prescribing medications for older adults, a good guiding principle is "start low and go slow." As we age, our kidneys and liver process medications differently, increasing the risk of adverse effects. You should probably generally avoid systemic Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like oral ibuprofen, as they carry significant risks for gastrointestinal bleeding, renal impairment, and cardiovascular events in seniors.

Instead, a good approach is topical analgesics as our first line of pharmacological defense. Prescription diclofenac gel, lidocaine patches, or capsaicin creams provide targeted relief directly to the painful area with minimal systemic absorption.

If oral medication is necessary, you may utilize acetaminophen with careful monitoring of your liver function, or specific nerve-modulating medications like gabapentin for neuropathic pain. Avoid opioids whenever possible due to the high risks of cognitive impairment, respiratory depression, and falls.

5. Interventional Pain Procedures

If conservative measures and topical treatments are not providing adequate relief, look at interventional procedures. You may wish to be referred to an interventional pain specialist. Depending on the exact etiology of your pain, you can utilize targeted therapies such as intra-articular corticosteroid injections to rapidly decrease joint inflammation or epidural steroid injections for spinal stenosis.

For chronic joint pain, you might also consider radiofrequency ablation, a minimally invasive procedure that uses thermal energy to temporarily interrupt the pain signals sent by specific nerve endings. These procedures are designed to give you a window of significant relief so you can actively participate in your physical therapy.

Sources

Centers for Disease Control and Prevention (CDC), Nonopioid Therapies for Pain Management cdc.gov/overdose-prevention/hcp/clinical-care/nonopioid-therapies-for-pain-management.html

MDPI Journal of Geriatrics, Management of Chronic Pain in Elderly Patients mdpi.com/2308-3417/10/4/110

National Institutes of Health / PubMed Central, Clinical Practice Guidelines for Chronic Pain, pmc.ncbi.nlm.nih.gov/articles/PMC12458848/

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