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Understanding Chronic Pain in the Elderly: Causes and Management
FOCUS Connect • 3 April 2025
Let’s face it—getting older often comes with its fair share of aches and pains. But when that pain sticks around day after day, it’s no longer just part of ageing—it’s chronic pain, and it can really take a toll. For many older Australians, conditions like arthritis, osteoporosis, or nerve-related issues become daily hurdles, affecting everything from their mobility to their mood.
So, what’s really going on behind the scenes? Why does pain become a long-term companion for so many seniors? And most importantly, what can be done to ease it? In this blog, we unpack the causes of chronic pain in the elderly, the unique challenges in diagnosing it, and the most effective ways to manage it—because everyone deserves to enjoy life, pain-free.
What is Chronic Pain?
Chronic pain is ongoing pain that lasts longer than three months, continuing beyond the expected recovery period of an injury or illness. Unlike acute pain, which serves as a short-term warning sign of harm, chronic pain often persists even when the original cause has healed—or can't be clearly identified.
In older adults, this type of pain is usually complex, involving a mix of physical, emotional, and psychological factors. The variation in pain intensity, frequency, and how it disrupts daily life makes it essential to tailor treatment and support to each individual.
Across Australia, more than 3.6 million people live with chronic pain, making it the nation’s leading cause of disability. The pain prevalence is particularly high among community dwelling older adults, who may also experience challenges with pain assessment due to communication issues, cognitive decline, or the normalisation of pain with age.
These factors all contribute to the under-treatment of pain in this group. Yet despite its widespread impact, there’s still a major gap in awareness, education, and access to effective care. Chronic pain patients often face barriers to treatment, with only one in every hundred Australians able to access multidisciplinary pain services. For many, the cost of care is simply out of reach, as current funding models leave them to manage significant out-of-pocket expenses.
For older adults, especially those living independently, addressing chronic pain requires not just medical attention, but a broader approach that considers their physical function, mental health, and quality of life.
The Connection Between Chronic Pain and Other Health Conditions
Chronic pain in the elderly frequently accompanies other long-term health conditions. Older Australians facing continuous discomfort are likely managing arthritis, diabetes, heart disease, or digestive issues simultaneously. This interconnectedness often exacerbates symptoms, complicating both diagnosis and management of pain in older adults.
The link between physical pain and mental health is particularly strong. Individuals experiencing frequent pain episodes commonly report anxiety or depression, creating a challenging cycle. Research shows those with chronic symptoms are more than twice as likely to suffer psychological conditions compared to their pain-free counterparts. However, determining whether mental health conditions cause or result from chronic pain remains complex, usually involving multiple overlapping factors.
Common Causes of Chronic Pain Conditions
Several factors contribute significantly to persistent pain among seniors, and understanding these causes can aid in effective management.
Chronic Musculoskeletal Pain
It is one of the most common triggers of pain in older adults, affecting their daily life:
- Arthritis, a prevalent condition among seniors, frequently results in chronic joint pain, stiffness, and reduced mobility, making everyday tasks difficult.
- Back problems are widespread among older populations, often caused by spinal degeneration, muscle strains, or cumulative injuries from past incidents.
- Osteoporosis causes bones to weaken and become brittle, significantly increasing fracture risks and leading to prolonged pain following injuries.
- Fibromyalgia is another notable musculoskeletal disorder characterised by extensive muscle discomfort, fatigue, and increased sensitivity to pain signals, deeply affecting quality of life.
Neuropathic Pain
Not all recurring pain arises from musculoskeletal issues. Neuropathic pain originates from damage or dysfunction within the nervous system, whether central or peripheral. Individuals often describe this type of pain as burning, stabbing, or experiencing electric shocks. It frequently occurs alongside tingling sensations, numbness, or hypersensitivity to touch. Diabetes, shingles, and nerve injuries are common causes.
Other Medical Contributors
Several systemic illnesses further contribute to ongoing discomfort among older individuals:
- Cancer pain can result directly from cancer progression or indirectly as side effects from treatments such as chemotherapy, radiation, or surgery.
- Diabetes may cause peripheral nerve damage over time, leading to neuropathy marked by persistent tingling, burning, or numbness.
- Endometriosis causes continuous pelvic discomfort due to abnormal tissue growth outside the uterus.
- Recurring headaches or migraines can become chronic conditions significantly disrupting daily life.
- Lung diseases such as COPD and cardiovascular conditions, including heart disease and stroke, often result in recurring pain or tension due to associated physical strain.
- Mental health challenges like depression, anxiety, and stress can exacerbate pain perception, increasing discomfort intensity and complicating management efforts.
Post-Surgical Persistent Pain
Surgical interventions, including joint replacements and spinal surgeries, aim to improve the quality of life for many older adults. However, some individuals experience ongoing pain after these procedures, hindering full recovery and complicating rehabilitation processes.
If you or a loved one is navigating these health complexities, partnering with a local My Aged Care provider can offer specialised guidance and services tailored to meet individual care needs.
Challenges in Pain Assessment for Older Adults
Assessing pain in older adults can be difficult due to a mix of communication issues, sensory decline, and common misconceptions. These factors often lead to pain being missed or inadequately managed.
1. Cognitive and Communication Hurdles
Conditions like dementia and delirium affect memory, language, and awareness, which limits an individual's ability to describe pain clearly. For example, someone with cognitive impairment may not understand questions about their symptoms or may struggle to find the words to respond.
Communication problems such as aphasia or hearing loss only add to the challenge. Pain-related behaviours—like restlessness or aggression—can be misread as part of dementia rather than signs of physical discomfort.
2. Underreporting and Common Misbeliefs
It’s not unusual for older adults to assume pain is just something that comes with age. As a result, they might not mention it unless asked directly. Others may avoid reporting pain because they’re worried about medication side effects, becoming dependent, or taking up too much of the doctor’s time.
In aged care settings, residents—especially those with cognitive impairment—are at greater risk of pain going unnoticed, as they may not be able to clearly express their discomfort.
3. Impact of Sensory and Physical Changes
Many older adults experience reduced hearing or vision, which affects how they communicate and respond during a pain assessment. Physical issues like limited mobility can also make it harder to evaluate pain accurately, especially when the person can’t move to show where it hurts or avoids certain movements altogether.
4. Clinical and Practical Barriers to Accurate Pain Assessment
Most pain evaluations still rely on people being able to describe their symptoms. But when someone can’t speak clearly or respond reliably, that system falls short. While standard pain rating scales are helpful for many, they don’t always work for those with communication or memory issues.
Observational tools, which focus on body language, facial expressions, or vital signs, can be useful in these cases. However, they require staff to be trained and have enough time to observe properly—something that’s often in short supply in busy care environments.
Effective Management Strategies for Chronic Pain
Effective pain management requires a multidisciplinary approach tailored to the needs of elderly patients:
- Medications
Pharmacological treatments play a role in pain management, but they must be used cautiously in older adults due to potential side effects. Common options include:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, such as ibuprofen and naproxen, reduce inflammation and relieve pain caused by conditions like arthritis and osteoporosis. However, prolonged use can cause gastrointestinal problems, kidney damage, and cardiovascular risks in older adults. Healthcare providers often recommend using NSAIDs at the lowest effective dose and for the shortest duration possible.
- Acetaminophen (Paracetamol)
Paracetamol is generally considered safer than NSAIDs for pain relief, especially in older adults. It is effective for mild to moderate pain and is commonly used for osteoarthritis and back pain. However, excessive use can cause liver damage, so it is important to adhere to dosage recommendations.
- Opioids
Opioids, such as morphine, oxycodone, and tramadol, are sometimes prescribed for severe pain that does not respond to other treatments. While they can be effective, they come with a high risk of dependency, drowsiness, constipation, and respiratory depression. Opioid use in older adults should be closely monitored, and alternative treatments should be explored whenever possible.
- Physical Therapy
Physical therapy plays a crucial role in pain management like arthritis, back pain, and osteoporosis. A well-designed exercise program can improve mobility, reduce stiffness, and strengthen muscles, reducing the burden of pain over time.
- Flexibility and Strength Training
Stretching exercises improve flexibility and prevent joint stiffness.
Strength training enhances muscle support for bones and joints, reducing pain intensity.
- Balance and Posture Training
Balance exercises reduce the risk of falls, which can worsen chronic pain in older adults.
Correcting posture helps alleviate pressure on the spine and joints.
- Hydrotherapy (Water-Based Exercises)
Exercising in warm water provides gentle resistance while reducing strain on the joints.
Hydrotherapy is especially beneficial for community dwelling older adults with arthritis or mobility limitations.
- Massage Therapy
Regular massage can promote blood circulation, relieve muscle tension, and contribute to pain relief.
It also enhances relaxation, reducing stress-related pain.
- Mind-Body Approaches
- Non-pharmacological methods, including meditation, tai chi, and acupuncture, have shown promise in alleviating recurring pain and improving emotional well-being.
The Importance of Social Support for Seniors
Social support plays a crucial role in both physical and emotional wellbeing. Pain doesn't just affect the body—it impacts mood, motivation, and overall quality of life. Having strong social connections can ease this burden in meaningful ways.
1. Emotional and Mental Health Benefits
Regular contact with family, friends, or carers can reduce loneliness and help seniors feel more connected and supported. Just having someone to talk to or spend time with can improve mood and reduce stress, which in turn may lower the intensity of pain.
2. Better Pain Management Outcomes
Research shows that seniors with strong social networks often report better pain outcomes than those who are socially isolated. Being around others can serve as a healthy distraction from pain and can even lead to improved coping skills over time.
3. Encouraging Healthy Habits
Supportive people can help seniors stick to treatment plans, attend medical appointments, stay active, and manage medications. Encouragement from others can be a strong motivator to engage in gentle exercise or maintain a balanced routine—all of which are important for managing the condition.
4. Practical Day-to-Day Help
Social support isn’t just emotional—it can also be practical. Help with shopping, transport, or household tasks can reduce the physical strain on someone living with ongoing pain, making everyday life easier and safer.
5. Reduced Stigma and Greater Willingness to Seek Help
When seniors feel heard and validated by those around them, they’re more likely to speak up about their symptoms and seek the help they need. Social support creates a safer space to discuss pain openly, making it easier to access treatment and stick with it.
Partnering with a trusted aged care service in Campbelltown can make a real difference—providing personalised support that addresses both the
physical discomfort and emotional challenges.
Final Thoughts
Chronic pain in the elderly is more than just an inconvenience—it’s a complex and often under-recognised condition that can seriously impact independence, mobility, and emotional wellbeing. Increased pain sensitivity in older adults, especially those with other health issues, makes it even more important to identify and treat pain early.
With the right support, pain management doesn’t have to be overwhelming. Whether it’s through tailored care plans, physical therapy, or stronger social connections, older Australians can take steps toward a better quality of life—one where pain doesn’t call the shots.
At FOCUS Connect, we understand the unique needs of seniors living with this condition. As an approved My Aged Care provider, we support individuals receiving Commonwealth Home Support Program services and Home Care Packages, helping them stay connected, safe, and well-supported at home.
If you or a loved one needs support, we’re here to help. Call us on 02 4627 1188 to learn more about how we can assist you in living more comfortably and independently.
FOCUS Connect, a registered not-for-profit charity, provides practical assistance and support services to disadvantaged and marginalised individuals. As a My Aged Care provider, we offer Home Care Package and Commonwealth Home Support Programme services across South West and Northern Sydney. Additionally, we are a leading provider of community services to multicultural and culturally and linguistically diverse (CALD) populations across South West Sydney.
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