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HEALTH FOCUS: Getting older doesn’t have to hurt!

By Grant Cooper, M.D. Princeton Spine and Joint Center
    When my grandmother was about 70 years old, her knees started to hurt. She went to her doctor and was told to take Tylenol. When the pain got worse, her doctor empathized with her and said it was hard to get old. He gave her a cane. When the pain got much worse, she was given a wheelchair and told that she was too old for a knee replacement.
    My grandmother lived until she was 93. The care that she was given for her pain was inadequate, substandard, and lacking in compassion. Her story is the reason I wrote the book, “The Arthritis Handbook: Improve your health and manage the pain of osteoarthritis,” and it was a large part of the reason I decided to become a doctor.
    My grandmother had a long and mostly happy life. She had a wonderful marriage, raised two children, was a civil rights activist, won a few dance contests, managed a hotel and got to meet Elvis Presley. In her later life, however, there were serious negative consequences of her knee pain getting worse and worse. First, my grandmother was unable to truly enjoy the 20 years of her life as much as she could and should have. She had to stop dancing. She did not go out as much with her friends and family. She could not even go for short walks.
    As the pain continued to worsen, she moved less, gained weight, and ultimately succumbed to heart failure that ended her life sooner than it may have otherwise. It is true that my grandmother endured pain at a time that many of the treatments we have today simply did not exist. But many treatments were available and her doctors did not use them because, presumably, they were ignorant of them.
    Unfortunately for my grandmother, her struggle with knee pain preceded the advent of the Internet and my family did not know to advocate for her or to find care elsewhere. The reason I tell my grandmother’s story is because it underlies a common misconception that I feel passionately about dispelling. Getting older does not mean that pain is inevitable. There are many effective, safe, evidence-based. non-surgical treatments for various arthritic problems, ranging from knee osteoarthritis to hip osteoarthritis to neck and lower back pain, shoulder pain, and a multitude of other musculoskeletal problems.
    My wife, Ana Bracilovic, is also a non-surgical musculoskeletal medicine doctor. We met in high school and ultimately did our specialty training in New York together at New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell before returning to Princeton to co-found Princeton Spine and Joint Center. Here, we see patients every day who have had pain for years and sometimes decades who thought that they, too, “just had to live with it.”
    Often, a patient will say that they mentioned to their doctor 20 years ago that their back was very painful but when nothing was done, they decided not to bring it up again and figured it was just “part of getting older.” Sometimes, and this is thankfully more and more rare, a patient will find us through friends or after hearing a lecture from one of our doctors, and tell us that they had pain that they were told to live with. They come after seeing that their friends have gotten better and they want to get better, too.
    For most people, most of the time, in 2011 pain can be successfully treated. Realize that treating pain successfully doesn’t always mean that it goes away 100 percent, but at least it can get better. As we get older, we are indeed more prone to a multitude of conditions, including heart disease and cancer. But if you develop heart disease or cancer, you don’t just throw up your hands and say “Oh well!” You treat it!
    Similarly, as we get older we may be more predisposed towards developing pain. However, that does not mean that we shouldn’t or can’t successfully treat that pain. We can, we should, and we do!
    Patients often present with questions such as: “How can you help my knee pain? My primary care doctor said you might be able to help me but I don’t know how. He told me that I have bone-on- bone arthritis. You can’t fix that. Don’t I just need a replacement?”
    We explain that their X- ray probably looked the same a year ago and even two years ago when they didn’t have the pain. The truth is that severity of arthritis on X-ray or MRI does not correlate well with severity or even presence of symptoms.
    It is not uncommon for us to see a patient with right knee pain but severe arthritic changes in both knees. The difference is that one knee has had an inflammatory response to the arthritis and is causing pain.
    Whenever I teach medical students or medical residents, one of the first lessons is that we treat people, not X-rays or MRIs. Often, addressing the inflammation through medications or injections and then addressing the biomechanics through stretching and strengthening the appropriate muscles both takes away and keeps away the symptoms. The same is true with degenerative disc disease in the spine and many other arthritic conditions.
    In the United States, we have a puritan heritage that affirms “toughing it out.” I can’t tell you how many patients I have had who said they felt bad about “complaining” about their pain. A few aches and pains are part of life, right? Perhaps, but when those aches don’t go away in a few days or weeks; when those aches start to interfere with our quality of life or the ability or desire to do certain activities of daily living, it is time to seek help.
    At Princeton Spine and Joint Center, all of our doctors share the singular purpose of taking away pain quickly, safely, and effectively and then getting people back to their pain-free, healthy lives.
    Not every patient has the same goals. Some patients want to return to sports and some simply want to be able to go for a long walk through a museum. We all delight in seeing our 70-, 80-, and, yes, 90- and-up-year-old patients return to golf and tennis.
    If my grandmother were alive, I’d be very happy to see her win a dance contest again.
Grant Cooper, M.D., is co-director, of the Princeton Spine and Joint Center. For more information, call 609-454-0760 or visit www.PrincetonSJC.com.