Thursday, January 17, 2013

Chronic pain increases risk of falling

...from dontfall.ca... by William Gage, Ph.D. Associate Dean, Research and Innovation, Faculty of Health, York University

When I wake up in the morning I am sore. A lot of you reading this are, too. I’ve said before that I was diagnosed a number of years ago with a form of arthritis called ankylosing spondylitis. In the morning, I am stiff and sore, especially in my feet and hips. Again, a lot of you reading this are, too. I can tell you from personal experience that my balance doesn’t feel all that great to me in the morning when my feet are sore. I feel more unstable – like I could fall, until my joints are feeling better – maybe after 10 or 15 minutes of walking around in the morning. How about you? This is chronic pain, and people with chronic pain are at a greater risk of falling.

There are a few definitions for chronic pain. A common one is “pain that last beyond the expected period of healing.” Often times, pain is considered “chronic” if it lasts more than 3 months or more than 6 months. Osteoarthritis is probably the most common cause of chronic pain. People will often take medication to try to control their pain, and people with osteoarthritis might take an anti-inflammatory medication. However, very little research has examined the relationship between chronic pain and fall risk.

As I mentioned, very little research has examined the relationship between chronic pain and risk of falling. But I think that a lot of you would agree that we feel unstable, at a greater risk of falling, when we’re sore. A recent study (click here for more information and a free copy of the paper) suggested that almost 30% of the population has chronic pain. Honestly, this number surprised me. This is saying that almost 1 in 3 people have chronic pain. This study used a survey to gather the data, and people with chronic pain might have been more likely to answer the survey. So this number might be a bit high. A number of other studies have put the number at more like 15% of people having chronic pain. There is no debate, however, that this number goes up with age. One estimate has 39% of people over the age of 55 having chronic pain; estimates are as high has 70% of people over the age of 65 having chronic pain (click here for a free copy of the paper).

Chronic pain contributes to reduced levels of activity, which itself leads to changes in muscle strength and endurance, and chronic pain is associated with depression. Depression, activity reduction and functional decline, and changes in muscle fitness are all factors that are associated with increased fall risk. Previous research (click here for a free copy of the paper) has shown that chronic pain is undertreated in older adults, and with the effects of pain on mobility, activity, muscle activity, and so on, it’s not a stretch to suggest that chronic pain could contribute to falling (as my own personal experience suggests could be the case, and your experience might, too).

A research team at Harvard recently examined falls and chronic pain in 749 older adults living in and around Boston ( click here for a free copy of the paper). Everyone was over the age of 70. They recorded each person’s pain – the focus of the study was on muscle and joint pain – and they tracked how many people fell over the next 18 months, and how often they fell. At the beginning of the study 64% of the people reported having chronic pain; 24% reported having pain at only one joint, and 40% reported having pain at two or more joints. Each month, any falls that happened were recorded, as was each person’s pain. People with pain at even one joint were more likely to have fallen in the past year; people with pain in two or more joints were more likely to have fallen than people with pain in only one joint. Balance was worse and people walked more slowly if they had pain in two or more joints. And, people with pain in two or more joints were more likely to fall in the coming 18 months than people with pain in only one joint. Very importantly, however, the researchers also reported that if the pain was worse for some reason one month, the risk of falling in the next month was much, much higher. The authors concluded the paper with “The findings provide evidence suggesting that the common complaint of the aches and pains of old age is related to a greater hazard than previously thought.”

Chronic pain – the common aches and pains that many, if not most, older people report – is a risk for falling. What can you do to reduce this risk?

...Talk to your physician. If you are a caregiver for someone who experiences (or might be experiencing) chronic pain, talk to his or her physician. Consult to make sure that you or your loved one is receiving an appropriate dosage of medication to control the pain and discomfort.

...With your healthcare provider’s input, start exercising. You do not have to exercise very intensely at all. If it’s safe, just get started. Regular exercise is associated, of course, with improved muscle strength and endurance, and improved cardiovascular health. But exercise also leads to improvements in depression and mental function, and, importantly, pain reduction. Again, if it’s a while since you’ve exercised or if you are experiencing chronic pain, speak with your healthcare provider before starting to exercise.

Chronic pain is associated with increased risk of falling. Talk to your doctor to ensure that pain medication levels are right, and exercise.

Join us for our Winter Education Series "Staying Safe and Healty at Home" and meet the author on Wednesday, March 27, 2013

"Why We Fall, and What You Can Do To Reduce Your Risk"

As we age, our risk of falling increases, One in three people over the age of 65 fall each year. What can we do to reduce your risk of falling? We'll discuss why falls increase as we get older and practical tips for reducing your risk of falling.

FREE and All Welcome!

Starts at 1:00 pm at the Evergreen Seniors Community Centre, 683 Woolwich Street Guelph, Ontario

To Register - please contact: Pat Gage 519-837-5696