Podcast: Aging doesn’t have to be painful

Most people believe that aging and pain go hand-in hand. In fact, one in four adults experience chronic pain, according to the CDC.

But pain isn't inevitable. Here to explain why is Dr. Ankur Patel, an interventional pain physician at Novant Health Pain Management - Thomasville. In this episode of Novant Health's Meaningful Medicine, Patel explains how you can prevent pain as you age, and address pain if you’re already experiencing it. Spoiler alert: If surgical intervention is needed, it’s usually minimally invasive these days.

Michael Smith, MD (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. And today I'm sitting down with Dr. Ankur Patel and we're going to be talking about addressing pain as you age. Now, before we get it started, Dr. Patel, tell us why you got into pain management. How did you make that decision to go down the pain specialist route?

Dr. Ankur Patel: Thank you again for the invitation and for having me here today, Dr. Mike. I would say that I kind of really got interested into pain medicine very early on in my medical training. So I was actually fortunate before going to medical school, I worked with a great neurosurgeon in the spine center.

So I really had a experience firsthand to kind of see patients who have chronic pain, chronic back pain, different conditions. And kind of seeing different surgical and non-surgical options we can offer them. And the really nice thing was that while I was working with these patients, I saw them before and after and how much their function and their quality of life improved.

So I think that was a big thing that kind of really stuck with me throughout my training. I really love neurology and different like musculoskeletal medicine and that kind of really poured my passion. I felt like this was my calling in doing pain medicine throughout my career.

Host: Oh, fantastic. So Dr. Patel, I think I'm a little older than you. I'm just going to say that. And you know, as I get older, I'm kind of getting the aches and pains a little bit here and there, but is experiencing pain as you age inevitable? Is there some hope for an old doctor like me?

Dr. Ankur Patel: Absolutely. I tell patients that we're going to have some impact on our body as we age, right? So as we're like 60 or 70, we're not going to be as fit and mobile as we were when we were 20s and 30s, right? But I think there's a lot of things that we can do as we age to prevent those chronic conditions from developing and to keep ourselves more mobile and functional. So there are a lot of tips and tricks and I hope we can discuss that today regarding those.

Host: Oh, no, I know. We're definitely going to get into that. But you just mentioned right there, acute, chronic. Let's talk about that for a second to make sure the audience understands what we're talking about, right? So there's acute pain, and then we also have the category of chronic pain, right? So what's the difference there to help the audience understand what we're talking about today?

Dr. Ankur Patel: So I usually kind of define this for patients more in timeline base. So that acute pain is typically that sudden onset of pain. So think about if you like sprained your ankle or you kind of fell and you kind of injured your back or that region. Usually that pain will get better with time, kind of some rest as time goes on and really pretty quickly within a couple of days or a couple of weeks, that pain should resolve.

Now, chronic pain is when we get into this realm of when this pain is really not improving and there's kind of going on and off for maybe several months or several years. And it's just taking a toll, not only on you physically, but then it has some emotional components too. And this pain overall kind of really encompasses you throughout your daily routine and really just affects your quality of life.

Host: Yeah. So, if an older person is listening to this, you know, it's kind of like every time you get up out of your seat, if you have some pain or something with that, if that's constant and constantly happens, you would call that chronic pain and they should go see somebody like you.

Dr. Ankur Patel: Yeah, I think that it kind of becomes the more chronic, especially in that timeline course that it becomes, it's not getting better. It's kind of been there throughout their day and it's kind of affecting them multiple times throughout the day and affecting their ability to kind of transition or walk and do things that's affecting their quality of life. So I think absolutely that is more defined on the chronic spectrum.

Host: As you see patients uh, especially on the older side, what's the most common cause of the chronic pain? Are we talking about joints? Are we talking about muscles? Are we like, well, what are we talking about?

Dr. Ankur Patel: Yeah. So I think it's a combination of all of it, but the most common I would say is arthritis, right? So we see arthritis that can form in different joints. So especially in my practice, I see a lot of patients who come in with back and neck symptoms. So a lot of it could be due to arthritis of the joints of the back and the neck.

Sometimes it can be some degenerative disc disease, like a herniation or a bulge that's affecting a nerve, and that's going to be causing some sciatica or pinched nerve symptoms, pain that's going down the leg. So there's a lot of different factors that kind of cause these chronic symptoms and that's kind of as our bodies age and these are more commonly degenerative processes, but there's things that we can actually do to help decrease the progression of those.

Host: Well, let's talk about that. Let's start off with a more general question about how you manage patients Dr. Patel. What kind of things do you do when a patient comes into your clinic, right, and you meet them and you're talking to them, you took your history, you got your physical exam.

What are you starting to think? If they have chronic pain, whether it's joints, whatever else, what are the things you're starting to think of right off the bat about prevention?

Dr. Ankur Patel: Yeah. So this is kind of when I really have that conversation and kind of really discuss that with the patient, right? To figure out what the goals are, right? So like one of my jobs I kind of say is not just to improve your pain, right? But to kind of improve your function and quality of life, right?

So I have patients sometimes say that, my pain is okay, it's bearable, but I can't go up and down the steps, right? So how can we help with that? So really figure out what the patient's goals are. And then we take it down and I tell patients that from step by step, right, we can really emphasize like a multi modal treatment approach where we can use different things in our toolbox.

So I like to recommend different areas of subspecialties such as physical therapy, kind of using medications. And what I specialize is a lot of interventions and injections to help patients so we can avoid those more surgical options if not necessary, right?

And in select patients, we may have to go down that surgical route, but if we can kind of really help improve their function and quality of life without that; a lot of my patients prefer that.