Pain and Aging I’m 84 and so it is natural that I surf the web for health-related sites for pain and aging, although I no longer have back pain, thanks to reading Dr. Sarno’s book Healing Back Pain, Steve Ozanich’s The Great Pain Deception, Alan Gordon’s TMS Recovery Program. Through following their advice that repressed emotions cause most if not all our brain when we grow older, I no longer have back pain. But I found a lot of web sites in which medical doctors discuss pain and aging, and found it interesting to see where they were coming from, and where and why the pain comes to older people. Before I summarize what I found from some of the doctors, I want to share what Dr. Sarno says on the subject of pain and aging: “TMS (Tension Myositis Syndrome) is a condition in which there is a temporary constriction of blood vessels, bringing on the symptoms [of pain in the back, neck, legs, etc.] and then all returns to normal [after you recognize they are being caused by repressed emotions]. “The emotional stimulus for [pain] is the same in adults as it is in children – anxiety. It is a substitute for a nightmare a child might have, a command decision by the mind to produce a physical reaction rather than have the individual experience a painful emotion. “The cause of most back [and other] pain is emotional, for the years between thirty and sixty are the ages that fall into what I would call the years of responsibility. This is the period in one’s life when one is under the most strain to succeed, to provide, and to excel, and it is logical that this is when one would experience the highest incidence of TMS.” Dr. Sarno says the primary tissue involved in TMS is muscle. The only muscles in the body that are susceptible to TMS are those in the back of the neck, the entire back, and the buttocks, known collectively as postural muscles. They are so named because they maintain the correct posture of the head and trunk and contribute to the effective use of the arms. He says it is not known why TMS is restricted to this group of muscles, but it may be because they have the most important jobs to perform. These are the buttock muscles whose job it is to keep the trunk upright on the legs, to prevent it from falling forward or to either side. Statistically, the low back buttock area is the most common location for TMS. Just above the buttocks are the lumbar muscles, in the small of the back. About two-thirds of TMS patients have their major pain in this area. Second in order of frequency of involvement are the neck and shoulder muscles. The pain is usually in the side of the neck and top of the shoulder, in the upper trapezius muscle. TMS can occur anywhere else in the back, between the shoulders and low back, but does so far less frequently than in the two areas mentioned. Dr. Sarno says a patient will usually complain of pain in one of these prime areas. For example, in the left buttock or the right shoulder, but a physical examination may very well reveal something else of great interest and importance. In virtually every one of his patients with TMS, he found tenderness when pressure was applied to muscles in three parts of the back: the outer aspect of both buttocks, and sometimes to the entire buttock), the muscles in the lumbar area and both the upper shoulder muscles. “This consistent pattern is important,” says Dr. Sarno, because it supports the hypothesis that the pain syndrome originates in the brain rather than in some structural abnormality of the spine or incompetence of the muscle.” The second type of tissue to be implicated in the pain syndrome is nerve, specifically those known as peripheral nerves. Those most frequently affected are located near the muscles that are involved. The sciatic nerve is located deep in the buttock muscle, one on each side. Lumbar spinal nerves are under the lumbar Para spinal muscles. Cervical spinal nerves and brachial plexus are under the upper shoulder muscles. These are the nerves most frequently affected in TMS. Varying kinds of pain may result when muscle and/or nerve are affected. The pain may be sharp, aching, burning, shock like, or it may feel like pressure. For me, after lifting something heavy the wrong way, my back and chest pain was sharp and burning. Also, besides pain, nerve involvement may produce feelings of pins and needles, tingling and/or numbness, even weakness in the legs or arms. Lumbar spinal and sciatic nerve symptoms are in the legs, because that is where those nerves are going. TMS may involve any of the nerves in the neck, shoulders, back, and buttocks, sometimes producing unusual pain patterns. Patients also have experienced chest pains and may be afraid they’re having heart problems. If upon a medical examination their heart is found to be normal, the patient needs to keep in mind that spinal nerves in the upper back may be suffering mild oxygen deprivation because of TMS and this may be the source of the pain. These nerves serve the front of the trunk as well as the back, producing chest pain. Dr. Sarno tells more about how the tendons and ligaments can be involved in TMS pain, but for now let’s see what some doctors say online about pain and aging. I’m not a doctor or medical expert, just a researcher, so I will not attempt to analyze their statements in connection or contrast with Dr. Sarno’s. I report on them below merely offering more grist for the mill of pain and aging. This following I have summarized from Pain.com, Your Pain Management Resource: As people get older, changes in the body occur that make a person more susceptible to certain medical conditions. For example, cardiovascular disease, type 2 diabetes, arthritis, osteoporosis, cancer and dementia are all more common in older individuals than in younger demographics, and many other disease processes follow the same pattern. Some of these conditions may result in acute or chronic pain. Getting older is not a guarantee of poor health, but everybody experiences natural changes in their body as they age that result in a higher susceptibility to certain conditions. One extremely common type of pain associated with aging is back pain. Back pain can be caused by a variety of different problems, from acute injuries to age-related degeneration of the joints or intervertebral discs in the spine. Degenerative disc disease is an age-related condition that causes the intervertebral discs to lose their flexibility and makes them more likely to rupture or herniate. Arthritis that affects the joints of the back can also cause back pain. Osteoporosis, a disease where the bones become thin and brittle, can also make an older person susceptible to vertebral fractures and fractures elsewhere in the body, which can be painful. Joint pain is also an extremely common age-related condition. Joints that are commonly affected by arthritis include the hip and knee joints. Osteoarthritis is the type of arthritis that is caused by age-related degeneration of the joint cartilage. Systemic conditions, such as type 2 diabetes, can cause pain if they are not properly controlled with medical treatment, diet and exercise. High blood glucose levels, over time, can cause a variety of health problems, including a painful condition called diabetic neuropathy. This condition is nerve pain in the hands and feet due to nerve damage in the extremities. Heart disease and cancer can also cause pain as a symptom, although pain is not always involved in every case. Hypertension (high blood pressure), for example, does not usually make the patient feel in pain or sick at all, even though high blood pressure can damage the heart and blood vessels and cause serious cardiovascular problems. In the absence of disease processes, there has been some investigation about whether a person’s pain threshold gets higher or lower as they age. It appears as though age has a slight effect on pain threshold; some people actually have an increased pain threshold as they get older. Age-related diseases and chronic pain do not happen to everyone as they get older, and they can be managed and treated when they do occur. The following is from Richard Sine, a WebMD feature reviewed by Dr. Jonathan L. Gelfand: Aging Is a Real Pain in the Neck. . . And the Back. And the Knees. But with stretching and exercise to relieve the pain, it doesn’t have to be. Mark Liszt, a food broker from Los Angeles, has had operations on both knees and a toe. A doctor has suggested a total replacement of his right knee, but he’s afraid it will affect his ability to play ball. At 59, Liszt can’t stop. On Tuesdays and Fridays, he plays basketball with guys who are sometimes half his age. On Saturday, he hobbles around all day with serious knee pain. Friends and family have referred him to doctors, but he’s stayed away. “I don’t want to be told what a fool I am,” he says. Liszt wants to be more active than his father, whom he says he can’t imagine playing sports at this age. Playing basketball, he says, makes him feel young and keeps him in shape. His inspiration is an 81-year-old teammate, Moe, who survived the Auschwitz concentration camp and is still a force on the court. “I said I’ll just keep playing basketball until I can’t,” Liszt recalls telling the doctor who recommended the knee replacement. “I want to be like Moe.” So for now, he’s decided to live with the aches and pains. For men approaching midlife, orthopedic surgeon Stephanie Siegrist, MD, has some good news: You can stay active and feel younger. But you’ll have to put some work into it. “I encourage patients not to think, I’m getting older, I’m deteriorating,” she says. Instead, she urges them to think “As I get older, I must invest more time and effort into maintaining my resilience.” Then, rather than diagnosing your own aches and pains, says Siegrist, author of Know Your Bones: Making Sense of Arthritis Medicine, you should seek out doctors who “understand your viewpoint” and will help you maintain a realistic level of physical activity. Why aging brings aches and pains As you age, the ligaments and tendons that hold your joints together become “stiff and leathery,” says Siegrist. At the same time, osteoarthritis can cause the cartilage in a joint to wear away. Both processes can lead to aching, soreness, and pain. The best way to feel younger, she says, is to condition your body in ways so that if you need to run to catch a plane or shovel the snow in your driveway, your body “doesn’t feel overwhelmed by the challenge.” Alan Hilibrand, MD, is an orthopedic surgeon and spinal specialist based in Philadelphia. He tells WebMD that arthritis can be especially debilitating in the back. While almost everyone over the age of 60 develops arthritis in the lower back, some develop degenerative disks as early as their 20s and 30s. Men run into problems when they fail to recognize their bodies are not as resilient as they once were, says Michael Schafer, MD, chairman of orthopedic surgery at Northwestern University’s medical school and a spokesman for the American Academy of Orthopedic Surgeons (AAOS). This is the “weekend warrior” syndrome: The guy who sits at a desk all week joins a pickup game of volleyball and ends up rupturing his Achilles tendon. The following from Beth W. Orenstein, reviewed by Dr. Pat F. Bass III. The Link Between Aging and Back Pain Bones and disks in our spines can degenerate over time, causing stiffness and soreness. But back pain doesn't need to be an inevitable part of aging if you take the right lifestyle approach. Oh, our aching backs! Nearly all of us experience back pain sometime in our lives, and the list of possible back pain causes is long — poor posture, being overweight, smoking, poor eating habits, spinal diseases, and other health conditions, including cancer. And then there's the number-one back pain cause: aging. Just using our backs over time can cause back pain, says Robin Lustig, DC, a chiropractor at New Jersey Total Health Center in Lodi and Pompton Plains, N.J. "It's just normal wear and tear." What's causing the ache? Your spine consists of individual bones called vertebrae, which are stacked one on top of the other. Between each vertebra are small joints that allow your spine to move and disks with jelly-like centers that act as shock absorbers and prevent your bones from rubbing against each other. As we age, the disks between the vertebrae wear away and shrink, which causes pain and stiffness as the bones start to rub against each other. In addition, the space around our spinal cord narrows over time. This condition, known as spinal stenosis, also puts pressure on the cord and spinal nerves, causing pain. If you overdo it, you may feel muscle soreness in your lower back. Should you break a bone or experience whiplash during your lifetime, you can accelerate a type of arthritis that can cause back or neck pain, Lustig says. While disk degeneration and spinal stenosis are most commonly seen in older patients, they are becoming younger persons' problems, too, Lustig adds. "I'm seeing so many more young people — people in their twenties and thirties — who, if you X-rayed their spines, would show some level of arthritis or degenerative changes." The reason is that more people, including children, are seriously overweight and have diabetes, which can create an inflammatory process in the entire body that results in neck and back pain, Lustig says. Finding Back Pain Relief If your back pain cause can be determined, the pain can be treated in three ways — with medications, therapeutic treatments or "physical medicine," and surgery, either singly or in combination. Medications for back pain relief include: Aspirin or acetaminophen Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen Steroids, which can be injected or taken orally Narcotics such as codeine or morphine Physical medicine: Rest or restricting certain activities Physical therapy, including active therapy (stretching, weight lifting, aerobics) and passive therapy (heat, ice, massage, ultrasound, electrical stimulation.) Braces, usually wrapped around the back and stomach Chiropractic or manipulation therapy Traction (although scientific evidence of its effectiveness is lacking) Stress relief such as Pilates, yoga, or meditation Surgery options: Spinal fusion to eliminate the motion between bone segments Disk replacement (similar to knee or hip replacement) Prevention: The Key to Back Pain Relief To keep your back from hurting as you age, it's very important to have good posture when you stand or sit, maintain a healthy weight, eat a good diet with needed nutrients for joint and bone health, exercise to keep your back and abdomen strong and flexible, and reduce stress. "People with healthy habits can age better," Lustig says. If you do experience back pain, even if you think the cause is aging, don't ignore it. It could be a sign of a serious, but treatable disease. You don't have to live with back pain, no matter what your age. Talk to your doctor and see what can be done to provide back pain relief. The following last entry is from Wyatt Myers, reviewed by Dr. Pat F. Bass: Treating Back Pain as You Age Is growing old giving you back pain? This all-too-common part of aging doesn't have to be a daily struggle if you identify your back pain symptoms and treat them properly. As much as we try to fight the signs and symptoms of aging, some foes are greater than others. And that is definitely the case with back pain. The majority of Americans will experience lower back pain at some point during their lifetime, and a small percentage will develop chronic back pain that lasts for more than three months. However, back pain symptoms do not have to be an inevitable part of the aging process. By understanding the different types of back pain, what causes them, and what your treatment options are, you can make great strides in keeping back pain from taking over your life. Types of Back Pain Lower back pain is the most common type of back pain. Typically, back pain symptoms include shooting or stabbing pain in the lower back, and they resolve on their own after a few days. However, lower back pain can be severe enough to limit your mobility or range of motion or even prevent you from standing up straight. In some cases, the pain can radiate to other parts of the body, such as the hips or legs. If the pain lasts for more than three months, it is considered chronic back pain. Though not as common, a spinal problem in your upper back can also contribute to back pain symptoms. Usually, this pain is accompanied by neck pain, and it can radiate to the shoulders and upper arms as well. Causes of Back Pain Back pain can be caused by a whole host of factors. Sometimes, your muscles lose elasticity, your bones lose strength, and your spine loses cushioning as you age, which in turn leads to lower back pain. Medical conditions such as arthritis, osteoporosis, viral infections, and other diseases can further contribute to the pain. Injuries are another common cause of lower back pain. If you’re in an accident or you simply lift something that’s too heavy, you can strain your spine and cause a disc to rupture or bulge outward. This puts more pressure on your back and the nerves within it, and pain is the unfortunate result. Finally, a number of risk factors can further increase your chances of developing back pain as you grow older. These include smoking, inactivity, being overweight, stress, poor posture, or poor sleeping habits, among others. Treating Back Pain In the past, standard medical advice for treating back pain may have been to rest until you begin to feel better. We now know that you should never just lie in bed for longer than one or two days at the most. Though it may be a little painful at first, research has shown that exercise might be the most effective method for treating lower back pain. By strengthening the back and abdominal muscles, you can reinforce your lower back to prevent future pain. There are some risks involved in exercising when you have back pain, and it’s important to start with gentle, low-impact exercises to prevent further damage. As a first step, discuss treatment options with your doctor, and then work closely with a physical therapist to determine the right exercises for you. In some cases, medications might be necessary for treating back pain. These often include over-the-counter pain relievers, such as aspirin, naproxen, and ibuprofen, or a topical pain reliever to reduce inflammation and stimulate blood flow. More serious medications, such as anticonvulsants, antidepressants, or opioids, might be necessary to stem severe pain and help you function. Some alternative therapies for pain that might be worth a look include chiropractic care, acupuncture, biofeedback, and ultrasound. Most types of lower back pain do not require surgery — it’s generally reserved for only the most serious types of back pain and spinal problems. Also, invasive back surgery is not always successful. If your doctor recommends surgery to treat your lower back pain, it’s very important to weigh the pros and cons of the procedure before making a decision. Back surgery can certainly be helpful for some people, but for many others, non-surgical treatment methods are a viable — and successful — option. There are more web sites about pain and aging, but these cover the subject quite well. It’s too bad none of the writers or doctors tell about the cure for pain and aging (or pain at any age) that we know about… that it is caused by TMS and our repressed emotions.