B: Grant Cooper, M.D.
Imagine the following scenario – a 78 year old man experiences chest pain and is taken to the emergency department. The emergency room doctor diagnoses the man with a heart attack. The man asks, “What do we do about it?” and the doctor responds, “Nothing, you’re 78 and these things happen when you get older.” And then the doctor walks away.
Of course the above scenario would never happen. It is and should be a repugnant idea to turn away someone with a life threatening condition whether they are 10, 50, 78 or 108. And yet, time and time again patients with a variety of musculoskeletal ailments (such as back pain, knee pain) are told, “this is just a natural part of aging” and thus they “should get used to it.” This message to patients at times seems omnipresent – from friends, family and yes, sometimes doctors. As a non-surgical spine and joint pain specialist, few things frustrate my colleagues and me here at Princeton Spine and Joint Center more.
The reality is that doctors understand most musculoskeletal problems, from back pain to neck pain to knee and hip pain, a lot better than even 15 years ago, and we have an ever expanding array of non-surgical and sometimes surgical options to effectively treat them. Why then does the “it’s just part of getting older so get used to the pain” myth persist? In our field, this is a topic of rampant conversation. My friend and co-author, Joseph Herrera, is the chairperson of Physical Medicine and Rehabilitation at Mount Sinai Hospital in Manhattan and he believes a large part of the problem is a failure of our specialty to adequately educate the public and other medical specialties. There is no doubt this is part of the problem – and it’s not an easy one to solve. New medical information is presented to us constantly about everything from high blood pressure to cancer treatments to stem cell therapies.
We also are immersed in a culture with puritanical roots and the “tough it out” mentality is something many of us take pride in. And “toughing things out” has a lot of positive aspects.
A quote from Voltaire is apt here: “The art of medicine consists of amusing the patient while nature cures the disease.”
Indeed, many aches and pains are mild and self limiting. Running to the doctor every time some body part aches for a day is going to leave you with little time for anything else. When should a person “tough it out” and when should medical attention be sought? The answer is a moving target and everyone has different thresholds, but as a general guiding principle, I think it’s fair to say that if pain is limiting your ability to enjoy your day or perform your daily activities, and if the pain is lasting for more than a few days, it’s time to call your doctor. Of course, if the pain is severe, you shouldn’t wait.
One reason to see a specialist with mild pain is that pain is sometimes a warning sign. As angina is a precursor to a heart attack, mild back pain may herald a serious issue. As with angina, addressing pain sooner is the best way to help prevent a more serious issue. An ounce of prevention is worth more than a pound of cure. Too many patients begin a conversation with me saying, “I’m not a complainer. I hate to bother you — but my back is killing me.” Patients don’t feel self-conscious going to their cardiologist with chest pain while walking because they understand ignoring it could lead to a heart attack. It’s time to help our communities not feel self conscious about going to their doctor with hip or neck pain because that too can have serious consequences if ignored.
For people embracing the ethos of the silent sufferer who takes pride in going it alone, I would simply remind them that there’s no punishment for being a martyr to their pain (other than the pain itself, lack of sleep, being more irritable, possibly increasing the risk of hypertension and depression to name a few issues) but nor is there a prize for their silent suffering.
Sometimes what stops a person from seeking help is they may have had the pain for a long time and they went to the doctor 10 or 20 or even 30 years ago and the doctor couldn’t help. Because of this, the person figured they had tried (which they did), and there was nothing to be done. While that may have been true in the past, our field is one of the most rapidly advancing ones and what might have been impossible to treat 20 years ago, might be easily treated today.
Let’s return to the issue of education, because it’s a huge one. In the last five years, new non-surgical treatments have emerged for a whole host of musculoskeletal ailments. For knee osteoarthritis, new viscosupplementation products, image-guided genicular nerve blocks, radiofrequency ablation and regenerative treatments are helping many who previously would have suffered. For spinal pain issues, superimposed on an already successful evidence based non-surgical algorithm, new modalities utilize improved ultrasound guidance. This merely scratches the surface of newer treatments. How do we get the word out? It starts, I think, with articles like this. It continues with community talks and with conversations with our medical colleagues in other disciplines.
If you or someone you love or even just like a little are in pain, please reach out and let them know that help is available, effective, and evidence based in 2019 going into 2020.