Singapore General Hospital shared a patient’s experience managing her chronic pain. Doctors can now better help seniors who are living in pain, to reduce their pain and improve their quality of life.
Doctors can now better help seniors who are living in pain, to reduce their pain and improve their quality of life
Madam Tan, 75, was a noodle stallholder who used to enjoy meeting friends, singing karaoke and doing Chinese calligraphy at the community centre.
However, she had to stop these activities when her lower back pain became so bad that she could no longer walk more than 10m at a time.
From time to time and even at night, she would experience the sensation of ants running up and down her leg, as well as a sharp, stabbing pain in her back.
The unpredictability of the pain attacks made her anxious and she felt depressed as she was no longer as mobile as she used to be.
Her spine surgeon recommended surgery to "free up her nerves and spinal cord", but she was not keen on surgery. She suffers from diabetes mellitus, hypertension and high cholesterol, which put her at higher risk of complications.
One day, after she had a fall, she went to her bed to take a rest. When she tried to get up later, she found that she could not do so. At the same time, she felt a sharp pain in the lower back - a feeling she described as being worse than labour pains.
Her youngest daughter called for an ambulance.
At the hospital, an X-ray showed that she had suffered a compression fracture in her lower back. She then had an MRI (magnetic resonance imaging) scan to determine whether the spinal cord and nerves were critically compressed, as this can result in paralysis.
Thankfully, this was not the case for Madam Tan, who was then admitted to the general ward.
Although painkillers eased some of her pain, she still experienced excruciating pain when she stood up. That slowed her progress when she underwent physiotherapy.
The care team referred her to the Pain Management Centre at the Singapore General Hospital.
All these took her family by surprise as she merely had a soft fall. Doctors explained that she had severe osteoporosis, which meant that even low-impact falls or sitting down too hard on a chair can easily lead to fractures.
In fact, Madam Tan's pain experience is very common among the elderly in Singapore.
The WiSE study published in the Pain Research and Management Journal in 2016 showed that about one in five patients aged 60 years and above will experience chronic pain.
About one-quarter of postmenopausal women will be afflicted by vertebral compression fractures and up to 40 per cent will have compression fractures by the time they are 80 years old.
Although compression fractures often heal by themselves, the severity of Madam Tan's injury meant that it would be best to perform a vertebroplasty procedure. This involves the injection of a special bone cement into the fractured vertebrae to restore the height of the vertebra, increase stability and reduce the pain.
This would help her reduce the amount of time she has to stay in bed and resume with physiotherapy. The risks of infection, bleeding and possible nerve damage were very low.
Madam Tan thus went ahead with the procedure, which was completed within an hour.
Her pain score and mood improved the next day, and she was glad to be mobile again.
The physiotherapist and occupational therapist prescribed exercises to improve her strength, fitness and function. Medications and injections were also planned to improve her bone density.
Four days later, Madam Tan was discharged. She was also scheduled to see a pain psychologist to help her overcome issues such as her anxiety and depression and pain catastrophising.
Patients with chronic pain have the tendency of ruminating on their pain and over-magnifying it, leading to a sense of helplessness.
Madam Tan's pain had paralysed her psychologically and emotionally. She had to be conditioned to process pain differently, so that it can be tolerated to her advantage, for example, for her to exercise and move around. This would allow her to build up her confidence once more and, perhaps, to return to doing some of the things she used to enjoy.
Although we cannot stop pain from happening by reversing the ravages of time and ageing, we can manage it better. Technology and advances in pain medicine have led to new and better pain treatments that are administered through minimally-invasive techniques.
We can now better help seniors who are living in pain, to reduce their pain and improve their quality of life.
•Dr Thor Timothy Anuntapon Chutatape is a consultant at the Department of Pain Medicine at Singapore General Hospital.