How some older Minnesotans are learning to live well with chronic pain

Andy Oman doesn't know whether her pain can be blamed on her genetics, her age or the high heels she wore during her corporate career.

"When you've been using your feet for 70 years, you're bound to have wear and tear," said Oman, an Elk River retiree.

Oman never knew when her neuropathy would flare up. The numbness, throbbing, tingling and burning that started in her feet sometimes crawled up her legs. It not only immobilized her but also robbed her of restful sleep.

"I was brought up Norwegian Lutheran: 'Don't complain.' My mother would say, 'Just get over it,' " Oman said. "Well, sometimes I can't get over it."

As people age, few of us are free of pain, whether it is persistent or shows up in the form of intermittent aches, twinges, soreness, pinches or prickles. The Centers for Disease Control finds that eight out of 10 older adults live with one or more chronic conditions that interfere with their everyday activities; pain results from disease, injuries old and new and the general creakiness that accumulates with years.

"Pain is our universal human condition; no one gets through life without it. But we want older people to be able to function, to live their lives," said Dr. Joe Bianco, a family physician in Ely, Minn., who also serves as director of the opioid stewardship program at Duluth-based Essentia Health.

Today, people coping with chronic pain — and their medical providers — are wary about turning to opioids to ease their ongoing discomfort. While narcotics are appropriate in some cases and for short-term relief, too many prescriptions have fed a dangerous cycle of cravings, dependence and addiction.

Prescription painkillers can cause troublesome interactions with the various medications taken by many older people. And the drowsiness and confusion associated with opioids increase their risk of falls and fractures that can be dangerous, even deadly, for those in their later years.

"We are changing and finding alternatives for treating pain. We need to do our due diligence and look at older bodies in a holistic way to give patients tools besides medication. Just giving them a pill doesn't understand them and doesn't do right by them," he said. "How pain is processed is dependent on many factors."

Bianco has found that a mental health screening can be a crucial first intervention.

"Even before the pandemic, people became more socially isolated as they aged, and that may leave them feeling sad and lonely. We know the pain threshold is lower for someone living with depression or PTSD," he said. "We might look at treating them with counseling and if we prescribe anything, it would be antidepressants."

Day by day

When someone is in chronic pain, they may show up at an appointment with their health care provider with a desperate plea to make it stop.

Patients might not want to hear it, but many doctors, physical therapists and other clinical pain specialists often recommend that they turn to non-pharmacological practices and routines as the solution to living with the hurt.

For the past few years, Bianco and other Minnesota physicians have been referring their older patients to a class called Living Well With Chronic Pain. The six-session course, developed at the Stanford Patient Education Research Center, is available at no cost across the state. It's offered through Juniper, a network coordinated by the state's Area Agencies on Aging that provides evidence-based health enrichment classes for older residents.

About 500 Minnesotans have now taken the pain management class, which is offered through various community-based organizations. In surveys, more than 90% of the participants said the class helped them to "better perform daily activities" and "manage their chronic condition."

Previously, attendees came in person to senior centers, health care clinics and faith communities, but the class has been offered virtually since last spring.

"With video conferencing, the class still has a peer-to-peer feel. There are some older people who don't have access to technology or broadband or don't feel comfortable using it. We have a conference line they can call in to and participate over the phone," said Sarah Blonigan, Juniper network director.

Social worker Melissa Gibbs leads the Living Well With Chronic Pain class offered through the Wilder Foundation in St. Paul.

"Chronic pain causes the nervous system to be overly sensitive, but there are practical things participants can do that help them with their day-to-day challenges. We teach them these things and then we practice them," she said.

Gibbs sympathizes with participants who are sedentary because it hurts to move. She reminds them that not exercising slows their circulation, increases their stiffness and ultimately worsens their pain.

"We show them the moving-easy approach, how they can adapt and safely make gentle movements," she said. "They see how their little decisions make a difference and that gives them a feeling of being in control. In class, it's helpful to hear what works for other people. It gives them ideas to try. "

Making an action plan

Andy Oman found the concepts she practiced in the Living Well With Chronic Pain class became a game changer. Once she learned about her pain cycle, she said, she developed an action plan to interrupt it and then endure it.

"Understanding the process doesn't fix it but it does help me manage it," she said.

During a flare-up, she works on her feet and lower legs with a handheld body massager, then rotates to over-the-counter lidocaine patches, ice or a CBD salve.

"For me, it's worse at night. I go to the couch to ride it out," she said. "When one thing fails, I try another and that calms me down. The pain is finite; I know it's going to end. That's where the mind over matter comes in."

Oman has added a tai chi practice to improve her balance, and tunes in for a half-hour Silver Sneakers workout to keep moving. She now takes a daily walk to a nearby park, something her pain had previously prevented her from doing.

"That's huge for me," she said. "When you can accomplish things, you get strokes that make you happy. You see that the pain doesn't control you, that you have control over your life. It's a good thing."

A toolbox for living with chronic pain

There is no one-size-fits-all approach to pain management. What does the trick varies from person to person, as does their perception of pain.

"One person's arthritic knee pain can be different from someone else's with the same amount of disease. How the individual brain processes pain varies," said Dr. Joe Bianco. "There was a time when everyone's experience with pain was looked at as a nail and opioids were the hammer. That got us into this mess and that's why we need other interventions."

Many physicians advise patients to use a combination of strategies to address pain. That may include prescription and over-the-counter medications but also relies on nonmedical interventions.

Keep moving. Being sedentary affects all organ systems and can lead to increased depression and anxiety. Gentle exercises like swimming, walking, biking and stretching can safely boost activity levels.

Physical therapy. It can target troublesome areas of the body with specific exercises; appointments with a physical therapist can build strength and flexibility and ease stiffness.

Reduce stress and relieve muscle tension. Add a mindfulness practice with meditation, yoga or deep breathing techniques.

Experiment. Integrative and alternative modalities like acupuncture, biofeedback or massage therapy can help mitigate pain.

Distract yourself. Listen to music or find an absorbing book, television show or movie. Watch comedies or stand-up specials that make you laugh. Like exercise, laughter releases endorphins, the body's feel-good chemicals.

Don't overlook the basics. Pain is worsened by a lack of sleep, poor nutrition and inadequate hydration, so make sure to rest, eat right and drink enough water.

Consistent care, delivered by a familiar health care team, is also helpful. Bianco, who has a roster of patients whom he has seen for decades, can put a problem with pain in perspective.

"There are pressures on providers to see many people in the day, but it's important that we have the time to understand the pain," he said. "When someone comes in with a complaint, I can tell right away, I know something is different."

Kevyn Burger is a Minneapolis-based writer and broadcaster.