Lower back pain is very common in the elderly. A lot of our elderly residents in the nursing home are suffering from chronic lower back pain which impacts on their quality of life to a varying degree depending on the severity of their back pain.
In fact, it is one of the main reasons why they often want to see the doctor or why nurses refer them to their GP (General Practitioner) almost every week.
For some, it may be a mild pain, “just an ache” as they would sometimes say because they are already used to it. Well, that is expected because they have probably already been suffering from it for years.
And for some, it maybe severe that it even changes the way they think and act or maybe the way they perceive life in general.
Before we start to discuss how to relieve lower back pain in the elderly, I thought it would be better if we know what lower back pain is and what are its causes in the first place.
What is Lower Back Pain?
According to the European Guidelines for prevention of low back pain, low back pain is defined as “pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain”.
Pain in the lower back often refers to pain of the muscles, tendons, intervertebral discs and joints in the lumbosacral region (the lower part of the spine). It can also spread in the buttocks or even down to the thighs.
Conditions that can Cause Lower Back Pain
1. Arthritis – The swelling and tenderness of the joints which happens because cartilage starts to become thin. It can be mainly due to osteoarthritis which is constant wear and tear or damage to the joints. Rheumatoid arthritis, which is an auto-immune disease, primarily affects the upper back but may also affect the lower back on rare occasions.
2. Disc injury – When a disc in any spinal vertebrae is strained and is pushed out of its normal shape. It could be due to general wear and tear resulting from repetitive actions/motions or sudden causes such as excessive impact or trauma resulting from a fall or any accident.
3. Muscle or ligament strain – Excessive weightlifting or such activities can give you muscle stretch which can cause pain or stiffness.
4. Sciatica – When a herniated disc causes pressure on the sciatic nerve, this can also cause severe pain radiating from the back down to the back of thigh. Sometimes it could be a feeling of numbness or tingling sensation instead of pain.
5. Spinal stenosis – A degenerative condition which may cause the spaces within the spine to become narrow thereby putting pressure on the spinal cord and the nerve roots.
6. Spondylosis – The wear and tear of the spinal discs which may result in the loss of structure and function of the spine. It is often due to old age.
7. Spondylitis – The inflammation or swelling of the spine or vertebrae. Over time, it can cause the fusion of small bones of the spine.
How to Relieve Lower Back Pain in the Elderly
When it comes to treating lower back pain, two distinct methods are being used. Both of these methods are effective, but the effectiveness varies from person to person.
It is worth mentioning that you must consult your doctor or know your medical conditions before picking any of these options.
Here are 2 ways on how to relieve lower back pain in the elderly:
This involves taking medications or drugs such as the following:
1. Non-opioids (Paracetamol)
2. Non-steroidal anti-inflammatory drugs or NSAIDS (Ibuprofen, Naproxen, Diclofenac, Celecoxib, high dose Aspirin)
3. Opioids (Codeine, Fentanyl, Hydromorphone, Morphine)
NOTE: Before taking any of these drugs, it is best for you to consult with your doctor/medical practitioner to make sure that it is safe for you and will not produce harmful effects when combined with any of your current medications.
Most of our residents are taking at least one of these medications to help with their lower back pain. But for some who are suffering from severe back pain, they are taking a combination of these analgesics to minimize the pain.
If you do not want to take painkillers all your life, the other option you have is to change your lifestyle.
There are a lot of non-pharmacological ways to alleviate lower back pain. They are recommended by doctors as they are natural and do not have side effects.
- Maintain Good Posture
Try to sit in the proper position to avoid lower back pain. While watching television or doing your knitting/crocheting, sit up with your back straight to avoid putting pressure on the spinal cord. Keep your shoulders relaxed and gently stretch your abdominal muscles to support your back.
- Be active
You should not let age stop you from doing something active. Develop an exercise regime. Go for a morning walk; fresh air has a positive impact on health. Try to be active in your daily routine so your body will maintain its flexibility and prevent weakness and stiffness of the bones and joints.
- Lose weight
Being overweight adds more stress to the joints and bones, especially on the lower extremities which can in turn affect the lower back as muscles tend to get pulled.
Improving diet is better than taking medications. Eat a well-balanced diet to maintain a healthy weight. As we age, eating nutritious food should be a priority in order to remain healthy. Try to avoid excessive oil, sugar and processed food. Include nuts, whole grain and other healthy options in your daily intake.
- Sleep well
Having good sleep is a simple cure for many health problems. However, it is difficult to sleep if you have back pain. You need to learn to relax. Listen to relaxing or calming music. Try putting a pillow or cushion under your knees or your back and sleep on your back to maintain proper alignment of your spine. Try to go to sleep and get up at the same time everyday to establish a routine. Limit naps to 15-30 minutes in the early afternoon so you can still sleep at night.
- Hot and Cold Therapy
The application of a hot pack to the lower back helps relieve pain by relaxing the muscles, improving circulation and decreasing stiffness of joints. Cold therapy, on the other hand, is applied to reduce swelling, constrict blood vessels and block nerve impulses thereby reducing the sensation of pain. Do not put the ice/heating pad directly onto the skin. Wrap it in a towel or a pillow case before using.
Regular massage to the lower back can help relax the muscles and reduce stiffness of joints which in turn relieves the pain.
Massage therapy can provide substantial benefits for alleviating lower back pain, especially if the correct muscle is targeted.
The technique used for the elderly does not differ much from the ones given to younger adults. The massage therapist just needs to be extra careful and be more gentle as older people’s bodies are more delicate and needs more attention.
Physiotherapy is one of the most effective ways to treat lower back pain. It helps to improve movement and function of muscles and joints. It also helps improve the flexibility and circulation of blood in the body. The physiotherapist will teach you proper exercise techniques to get rid of the back pain. Try not to do it on your own without seeing a qualified physiotherapist as it might lead to any further injury or spinal problems.
Most of our residents are having hot pack either daily or 2 times a day. It has become a daily routine for them and they are enjoying it.
Some of them have regular massage given by either the Registered Nurses weekly or by the Physiotherapist/Occupational Therapist 4 times a week.
They regularly attend individual and group exercises as well. It helps them move around and it also serves as their socialization with other residents.
Surgery is Another Way to Relieve Lower Back Pain
If all the pharmacological and non-pharmacological interventions seem to be ineffective, then you may want to consider the possibility of surgery. Surgery is recommended if pain is persistent or when there is severe compression of the nerve or spinal distortion.
As surgery is a big decision, you might want to get a second opinion to check whether it is really necessary. Discuss it with other family members to make sure that everybody is on board. You can also try to get feedback from someone who has had successful surgery in the past for your peace of mind.
Negative Effects of Lower Back Pain
If left untreated, chronic lower back pain has some negative impact to the quality of life of the elderly.
Some of them may develop depression and anxiety which makes the condition worse as they feel pain more acutely and may become more disabled by it.
Some of our residents sometimes ask “What is the point of living if you are suffering in pain?”
These type of residents need to be referred to a specialist as they may need some psychological counselling to help them develop strategies to deal with detrimental thoughts.
Activities of daily living can also be affected if an old person is having chronic lower back pain. They are unable to do things for themselves thereby requiring more assistance from other people.
They may also lose their appetite, be unable to sleep well or may even lose interest in joining any physical and social activities if they are suffering in pain.
Old Lives Matter!
Having chronic lower back pain is not a joke! It has to be addressed immediately and properly.
Old age should not be a reason to ignore the suffering of a person. Instead, they should be looked after the way we want to be cared for when we reach their age.
They need more attention so they can get the proper treatment as soon as possible to prevent the pain from getting worse. If their pain is managed properly, they will still enjoy life and will continue to do the things they love to do throughout their old age.
I don’t know about you, but my pain threshold is really low. That is why I could relate to our residents every time they complain of pain.
And I, for one, don’t want to wait for a long time while suffering in pain!