Wave of pain to come for boomers
Pain series
TODAY: While statistics indicate that boomers will live longer than any previous generation, pain specialists worry that the quality of life may be severely compromised.
Working through the pain not so productive Until recently, it was assumed that pain caused lost productivity at work when hurting employees took time off.As boomers hit their `achy-breaky' years, they are bracing for the tsunami of pain that comes with living longer
Oct 06, 2007 04:30 AM
David Graham
Living Reporter
Ten years ago, Anna Di Rezze woke up suddenly in the middle of the night. For no apparent reason, she was in agonizing pain.
"I was alone in bed and I couldn't move," she recalls.
"I felt as if someone had hit me with a baseball bat. I thought I was having a stroke," says the 48-year-old U of T grad student. "I took Tylenol and Aspirin. And in the morning I was still incredibly stiff."
Though it took a year, Di Rezze, who had always been active, particularly as an enthusiastic equestrian, was finally diagnosed with rheumatoid arthritis.
Pain has been part of her life ever since. She's continued to work and ride horses. She married and recently returned to school. But her life has never been the same.
"In 10 years I have never been out of pain. I just have higher and lower levels and luckily I have more good days than bad," she says.
Over the years Di Rezze has been prescribed a variety of medications, including Celebrex for the pain of arthritis. She's dabbled in magnetic therapies, herbs and acupuncture.
"Now I feel flare-ups coming and I prepare myself. I can feel the heat building in my arm and I can see my hands curling up."
As aging baby boomers enter their "achy-breaky" years, scientists and researchers are scrambling to discover remedies for the tsunami of pain that threatens to cripple the population over the next few decades.
While statistics indicate that boomers will live longer than any previous generation, pain specialists worry the quality of life during those final years may be severely compromised by the many and varied pains associated with growing old. That includes pain from cancer, musculoskeletal and joint disorders, neck and back pain, as well as headaches and migraine.
Dr. Mary Lynch, president-elect of the Canadian Pain Society, sees the killer wave coming.
Lynch is a professor of psychiatry, anesthesiology and pharmacology at Dalhousie University and director of the pain management unit at the QE2 Health Sciences Centre in Halifax. She cites Canada's Dr. Dwight Moulin's study on pain, which estimates 29 per cent of Canadians aged 18 years and older suffer from chronic pain.
"That number is going to explode as the population ages," she says.
Moulin, a physician at London Health Sciences Centre in London, Ont., is a leading researcher in cancer pain. He has commented: "In the developed world, approximately one in three individuals will be diagnosed with cancer and one-half of those will die of progressive disease. At least 75 per cent of patients with cancer develop pain before death. It is therefore not surprising that pain is one of the most feared consequences of cancer for both patients and families."
As Woody Allen once cracked: "It's not that I'm afraid to die. I just don't want to be there when it happens."
Remarkably, Di Rezze counts herself lucky, if only because she has learned relatively early in life how to cope with persistent pain.
Millions of aging boomers are going to learn her lessons, says Lynch.
From the gnawing agony of arthritis to the torture of cancer pain, the scientific medical community is determined to tame this multi-tentacled beast.
There is a lot of territory to cover. Despite the warnings, too many hospitals continue to under-treat pain. Wait times in both private and public clinics can encourage sufferers to medicate themselves. And still, too few medical schools are teaching pain management, says Lynch.
Yet amidst all the agony, there is hope, mostly because pain is finally being taken seriously as a disease in its own right, no longer considered just a maddening side effect of other illnesses and trauma.
"I have been working in pain for the past 25 years and for most of that time it was a backwater," says Mike Salter, director of the Centre for the Study of Pain at the U of T. He's buoyed by the fact pain is now an exciting field that's beginning to attract more researchers.
Canada, in fact, has become a world leader in pain research, says Lynch.
And members of the boomer generation will be the ultimate benefactors. Often characterized as self-indulgent, boomers – unlike previous generations – are less likely to suffer silently and will not tolerate a medical community that makes them feel crazy simply because they want relief for what seems like an inexplicable pain.
We need to get on top of this issue now, says Lynch.
Enormous strides have been made in the understanding of the mechanics of pain, particularly the difference between acute and chronic pain.
Acute pain (pain following a surgical procedure or from an accident, for example), is understandable and treatable pharmacologically, says Salter.
But chronic pain, which persists beyond the time when normal healing should have taken place, points to an unhealthy nervous system, he says. And that's a considerably more complicated issue. "Think of those pain messages being stuck in the `on' position," says Lynch. "The nervous system is hyper-sensitized and keeps firing in the absence of pain-related events."
"Science is now focusing on finding new ways to restore healthy function to the nervous system," Salter says.
And he's optimistic.
"It is not science-fiction," he says, "to contemplate a world in which all pain is treatable, particularly since the important breakthroughs in neuroscience in the early to mid-'90s. In a perfect world, people will decide how much pain they are willing to endure. They'll balance the negative side effects of their treatment against the pain relief."
Montreal's Dr. Ronald Melzack got the ball rolling in 1965 when he and British physiologist Patrick Wall published their famous gate-control theory.
According to their research, psychological and environmental factors can influence how we feel pain. Sometimes the source of pain is in the brain, which they suggest, explains phenomenon such as phantom limb pain.
Melzack, a professor emeritus at McGill University and associate of the McGill Centre for Research on Pain, says their groundbreaking theory "triggered a revolution in the research of pain. It put the brain front and centre as an integral part of our understanding of pain. It brought the field of psychology to the understanding of pain."
Melzack is convinced new pharmacological advances in pain alleviation will come from the study of antidepressants, anti-epilepsy drugs and cannabinoids – treatments that serve to dampen down nerve firing.
Pharmaceutical giants spend millions researching magic bullets. It's big business. And as boomers age, it's about to get bigger.
In 2006 in Canada, 26 million prescriptions for painkillers were issued, according to IMS Health Canada, representing sales of more than $800 million.
But pain specialists know drugs alone are not the answer. Pain has to be attacked on a variety of fronts.
Dr. Allan Gordon, director of the Wasser Pain Management Centre at Toronto's Mount Sinai Hospital, confirms that patients treated with a multidisciplinary approach consistently do better than patients who rely on drugs alone. Lynch agrees: "Appropriate pain management needs a holistic approach."
The Wasser clinic, opened in 1999, treats pain on many levels – opioids, including narcotic pain medications such as codeine, fentanyl, morphine and oxycodone; injection therapies such as nerve-blocking epidurals and Botox; physical therapies to tone the body's defence network; behavioural techniques such as relaxation and biofeedback as well as psychotherapy that addresses the fear, anxiety and depression associated with pain.
The team approach at Wasser, which treats chronic pain not related to cancer, uses the expertise of neurologists, dentists, anesthesiologists, gynecologists and even sex therapists.
Doctors involved in pain management are not discounting any treatment options, from implants and patches to hypnosis and acupuncture.
"What we know is that there are many ways to change the way someone feels. What about the power of spirituality and music?" Gordon wonders. "These should be researched more," he says.
Pain specialists continue to work on technologies such as pumps that send pain medication directly to the spinal cord and pain pacemakers, devices implanted in the body to deliver low-level electrical signals to the spinal cord or to specific nerves.
Researchers are experimenting with genetics and there are murmurings of stem-cell technologies.
McGill psychology professor Dr. Jeffrey Mogil is the Canada Research Chair in the Genetics of Pain and a member of the McGill Centre for Research on Pain, which was created in 2003 and now has 30 full and 17 associate members.
The relationship between genes and pain represents the newest and perhaps most promising research. "We want to know why only a small portion of people with certain disorders feel intense pain while others are largely unaffected.
"The answer may be in the genetic variations between people," says Mogil.
"There has to be a genetic component," he says. "When 100 people are in the same car accident and only six go on to experience chronic neuropathic pain, unless the injuries were different, the six sufferers must have a genetic susceptibility to their pain. And when 100 people get headaches and some respond better to ibuprofen than others, then we suspect the issue may be genetic," says Mogil.
"There are a lot of people around the world working on many, many theories," says Salter. "Which ones will pan out is hard to know."
But boomers are not stoics, says Lynch. "As a demographic, they are used to taking an active role in their health. They'll be politically pro-active. They'll want answers."
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