August 2, 2002
The news was not good for Mary Larson. She was diagnosed with postherpetic neuralgia after she suffered a bout of shingles.
The condition, common in people over 50, occurs when the pain from shingles persists beyond one month even if the rash associated with shingles disappears.
Larson, an Arlington resident, visited her doctors, who eventually referred her to the Fairfax Anesthesiology Associates Inc., Acute and Chronic Pain Management Services when they could no longer stop the pain.
"I was hoping it wasn't going to be a constant thing," Larson said. "I had a series of shots, but they said I would have a 50-50 chance of recovering. I've now had it for three years. The pain clinic has been very helpful. They've been able to regulate my medication and when necessary I take pain pills."
CHRONIC PAIN, such as arthritis, spinal stenosis, and pain in the back and knees, is common in the elderly, said Dr. Greg Fischer of the Fairfax Anesthesiology Associates Inc., Acute and Chronic Pain Management Services.
"A lot of people worry about prescribing medications to the elderly because they are more likely to have side effects from anti-inflammatory medication and can see problem with ulcers and the kidneys," Fischer said. "A lot of doctors are also hesitant to prescribe narcotics because of the worry with side effects and less with addiction."
The Pain Management Services, which has an office in Inova Fairfax Hospital, gives patients shots called neuroblockers, which numb the nerve and decrease irritation to the nerve to help break the cycle of pain, said Fischer.
Doctors, however, are not always the only ones worried about the effects of the medications.
"With the pain pills, if I catch the pain before it becomes severe, it's better. But I always think it will go away and it doesn't," Larson said of her reluctance to take her pills. "I don't want to take so much of the medications. That's the feeling in my head. I've finally discovered that's the answer and now I try to take them when needed."
Like many seniors, Larson takes medications other than the pain pills prescribed for her postherpetic neuralgia.
FOR THOSE LIKE LARSON who do not want to feel mediated all the time, exercise is the next best way of fighting the pain.
"Arthritis is a major source of pain. But we do find that despite the pain, seniors need to keep moving, stay active, so that they don't lose their range of motion," said Brad Hibbs, Greenspring Village's wellness manager. "Generally with pain when you're exercising, it's your body telling you it's too much. In this case, you have to encourage people to workout and continue to do things as long as they can."
Hibbs said the fitness experts at Greenspring do not allow any of the seniors to participate in exercise programs or work on the fitness equipment until first consulting with their doctors to see what the senior can and cannot do. And while they encourage the seniors to continue working out through the pain, they do not push them beyond what their doctors dictate.
"Exercise programs like water aerobics, yoga or Tai chi, or even walking will help strengthen muscles. While you have some relief [through medications], start exercising and gradually reduce the medications. Patients will find if they do that, if they stop exercising the pain gets worse," Fischer said. "Studies show exercising is good for the pain and for the piece of mind."
Larson said she has found her pain gets worse if she gets over tired or stressed, so she stays active and paces herself.
Keeping the mind active can also help keep the pain away. At Arleigh Burke Pavillion, a continuing-care retirement community, besides the traditional methods of pain relief such as medication and physical therapy, the staff practices what administrator Robert DeMaria calls "diversionary activities."
"Sometimes if a person lives with pain, the on-set of that pain can be just as stressful," DeMaria. "If the person tries to keep occupied in their pain-free moments, it helps keep the mind from thinking about the pain."
Most of all, DeMaria said a key to combating chronic pain is a positive outlook. "Optimistic people do better than pessimistic people."