It hurts so much I can’t walk

“My 82-year-old Mom has had back pain for decades. She had back surgery, but the pain came back after 5 years. Then she had kyphoplasty but that only helped for about a year. Since then, she’s had injections and taken many pain medications including narcotics. Sometimes I think she’s drugged. Now she also has neck pain. She’s investigating stem cell therapy. What do you think?”

Stem cell therapy has been used for degenerative disc disease of the back. The intent is to grow cells that restore the disc and decrease inflammation. Patients with less severe disease are more likely to respond. More data is needed to prove its efficacy. As a result, it is not FDA approved for this purpose. Medicare does not pay for this use of stem cell therapy.

In the years ahead scientific advances will decrease the prevalence of chronic pain. Synthetic biomaterials are an exciting area of research. They are being explored to replace damaged human tissue. Hip replacements are an example of an existing biomaterial.

Your mother is suffering and it’s good that she is looking for answers. One option is to see a pain specialist who can discuss approaches such as stem cell therapy. It’s important not to let pain dominate her life.

Chronic pain IS more common with aging.

Pain isn’t a normal part of aging. But it is easy to see why people think that. Persistent pain is present in 20% of young people. But by the time people reach the age of 85, the prevalence is up to 80%. It is sometimes severe, daily, and disabling. Most pain is musculoskeletal or arthritic. Pain is frequently multifocal. More than one third of elderly people have low back pain. Injury, cancer, and neuropathy also cause pain. Pain can lead to falls which then results in more pain.

Pain can also have rollover effects on other aspects of life. It can lead to problems sleeping, fewer activities, isolation, and depression. Disagreements about the pain severity can cause frustration, anger, and/or exhaustion. In the worse situations, an angry chasm opens between people who live with pain and others.

An ABC approach to Pain

Pain should never become a spiraling problem. Instead, an ABC approach is needed. These steps are not easy but are essential to obtain a good outcome.

A. Make sure the person feels supported. Listen without judgement. If a person says that he/she is in pain, then he/she IS in pain. Support comes in the form of patience, encouragement, coaching, and commitment. Some people are exceptionally good at this, but many are not. That’s why it’s important to create a trustworthy support network. The network can include loved ones, a close friend, a spiritual guide, a professional, another person who has pain, or a support group. It is just as important that loved ones and caregivers get support to avoid burn out and frustration. I can’t overemphasize the importance of support. People need to help each other.

B. Try different approaches and don’t give up. Medicines can help but so can other therapies. The goal is to find the approach that works best for each person. The next post will be about the benefits and risks of various medications. After that, there will be a discussion of other pain control approaches. Some things work for some people but not others. Approaches also change over time. The American Chronic Pain Association has a video entitled “A Car with Four Flat Tires”. It describes the need for multiple approaches.

C. Have a specific achievable goal. Complete relief from pain is not usually possible. That type of goal leads to disappointment. At the same time, it’s important not to give up and let pain take control of life. Goals can be related to emotional state, activities, social interactions, and pain control. An achievable goal doesn’t mean it’s easy. It requires continued effort despite setbacks.

In Summary: Chronic pain is common and challenging in older people. It has a ripple effect on quality of life. Support, multiple approaches, and a realistic goal are essential. The 2-page form below provides an excellent starting point for this ABC strategy.


These posts will not be about managing acute pain. Consult a healthcare provider for new or unexplained pain. It’s important to point out that acute pain is not always severe. It can be an unusual but important sensation such as chest discomfort.


Warmest Aloha,

[email protected]

PS: I say it over and over again: There’s no one more important than the caregiver in the daily life of a frail person.



Posted in Caregiving, Dr. Warren, Geriatrics with Aloha and tagged , , .

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  1. Pingback: The Role of Medicines in Pain Control: Part 1 - Geriatrics with Aloha

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