Aging and Pain

The anti-aging industry is a large and growing segment of our economy. But the majority of the treatments offered, from skin creams to plastic surgery, are designed simply to make you look younger. Although some anti-aging treatments also stress the importance of what goes into the body, the promised results—characterized by words like rejuvenate, lift, and revitalize—are mostly cosmetic. While I hope that you’ll continue to look great at any age, my real wish is to help you find a path that leads you to feeling wonderful, too. And in order to do that, you’ll need to start investing in your health right now. You can’t expect to feel like a million bucks at age eighty-five without having put in some investment first.

Consider thinking about your health the same way you think about your finances. Unless you’re very young, you’ve probably already started planning for your retirement and stashing money away. My wife and I met with our financial planner years ago to figure out how much we needed to set aside each month and how to invest it. This makes perfect sense. And it also makes perfect sense to make plans to preserve and protect your health so you can reach age eighty or ninety with a maximum of physical and mental abilities and a minimum of pain. This is particularly important today, as modern medicine has the ability to fix body parts that in past generations might have worn out or shut down. These new techniques can add extra years to your life, but during those additional years the potential for chronic pain can skyrocket. As medicine gets better at prolonging the lives of failing organs, we need to be mindful of how we will live and function with a mixture of strong and not-so-strong “parts.”

One of the things that saddens me most is seeing an elderly person who suffers from tremendous discomfort due to the steady deterioration of the body. I ask myself how I can help such a person when the source of the anguish—aging—can’t be reversed. I’ve come to the conclusion that the best way to minimize pain and disability in old age is to take good care of the body throughout life and take special care to prevent the most common sources of age-related chronic pain.

While the potential blessings of being around for an extra decade or two are too numerous to count, the added years also pose new challenges, including how to deal with the pain that might pop up. James Fries, MD, argues that good lifestyle habits can help you enjoy a very healthy life right until it’s time to die. Unfortunately, introducing miraculous medical treatments that preserve worn parts throws a bit of a wrench into the whole compressed morbidity concept.

Must Age = Pain?

The fact of the matter is that growing old is a risk factor for developing chronic pain. The most common “pain culprits” are arthritic joints and a degenerating spinal column. The joints and spine work mighty hard to support the body throughout the eight or nine decades that most people live, but, because of the wear and tear of usage and the strain caused by pushing against gravity to keep the body upright, they also suffer injuries. Just as the soles of your shoes wear out if you wear them long enough, the supporting elements (including the cartilage) in your joints and spine, eventually break down. As your natural padding and cushioning give way, things start to grind, get inflamed, and hurt. In addition there are the injuries we all suffer due to trauma. Many of us carry around the scars (inner and outer) of skating crashes, football injuries, motor vehicle accidents, and just plain old falls.

Both of my grandmothers lived well into their nineties, despite being orphans who had very trying life experiences. My maternal grandmother was diagnosed with a problem called critical aortic stenosis when she was eighty-three and had to have her aortic valve replaced with a pig valve.

Critical aortic stenosis means there is a blockage at the valve that overwhelms the heart’s ability to pump enough blood to sustain life.

She was a strong woman who had overcome much in life, so we were not surprised that she lived another ten years—despite a life expectancy of five years tops for the average patient with critical aortic stenosis. This extra ten years blessed all of us with many rewards, including the chance for my own children to know her. Unfortunately she also had many bad days over those ten years. The arthritis in her knees was so severe that movement was often excruciatingly painful for her. Despite having a grandson who was a well-respected pain doctor, there was no magical solution to her problem. The window of opportunity had passed for knee replacements—she was simply too fragile due to her medical condition. There was no compressed morbidity for my grandmother.

I’m afraid situations like this are only becoming more common. Americans over age sixty-five are a large and growing group, and there are an estimated seventy-eight million baby boomers who will keep replenishing the ranks of our senior population for years to come. As medicine gets better and better at prolonging the life of failing organs, we need to begin thinking now—before it is too late—about taking the steps that will allow us to remain healthy, pain free, active, and alert right up until the end of a long life.

Common Sources of Age-Related Pain

The most common sources of age-related pain include problems with the spine, reduced muscle mass, a decline in balance, obesity, arthritis, osteoporosis, and, surprisingly, the mind itself.

Pain Related to the Spine

As we get older the entire spine changes. The protective disks between the vertebrae lose water and thin out, and the cartilage that lines the joints and prevents the bones from rubbing against each other begins to wear away. The net effect is that the spine gets shorter, which causes it to rotate and curve. This is why older people lose height and can become stooped. In effect, their backs are coiling up.

As this process of degeneration and compression takes place, vertebrae can rub together and damage each other. This, in turn, can trigger the growth of bone spurs as the body tries to heal the damaged areas but “grows back” too much bone. Meanwhile, as the spine degenerates it can put pressure on the nerves that are intertwined with the spine, causing neck pain, back pain, or sciatica (back pain with shooting pain down the back of a leg).

None of these structural problems occurs overnight; they develop slowly over a period of many years. As they occur, the rest of the body (including the heart, liver, kidneys, and brain) ages, too. While modern medicine can often keep these organs working well enough to lengthen life, the spine and other tissues continue to wear out, causing chronic pain. So, thanks to medications, an elderly woman with severe spinal deterioration might be able to stay alive for an extra decade. But how will she tolerate living in her body? Too many patients have said to me, “Doc, this ain’t living!”

Reduced Muscle Mass and Obesity

As we age, our body composition changes and we naturally lose muscle mass and gain fat. One reason this happens is that the endocrine system changes. The endocrine system consists of the pituitary gland, thyroid gland, pancreas, ovaries, testes, and other glands and tissues that secrete hormones that influence metabolism, hunger, sleep, growth, and sexual development.

Women’s levels of estrogen and progesterone change dramatically due to menopause, while men experience gradual declines in testosterone levels. These hormonal changes make it harder to maintain muscle mass and, unfortunately, easier to create and store fat around the midsection.

Not only do muscles help us move, they also support the skeleton. The greater the “support load” taken on by the muscles, the less stress the joints have to endure, which helps them last longer. Conversely, as the muscles weaken, the load on the joints increases, ratcheting up the likelihood of arthritis and a decline in the ability of the joints to bear weight. When this happens, it becomes more difficult to participate in weight-bearing activities like standing, walking, running, dancing, and climbing stairs because they become too uncomfortable to tolerate. This can have a devastating impact on your life, for such activities make it possible to buy groceries, visit neighbors, pick up the mail, clean the house, and take care of the garden. As weight-bearing tolerance declines even further, basic activities like getting out of bed, going to the bathroom, and preparing meals can become real struggles. Even in our era of cars, elevators, and motorized scooters, the less you are able to move and walk on your own, the smaller your world becomes. And it can happen surprisingly quickly: Once muscle mass begins to decline, a person can go from shopping at huge malls and hiking in national forests to being confined to home in a relatively short period of time. As the muscles shrink and getting around becomes more and more difficult, you can find yourself interacting with far fewer people and becoming closed off from your community. I’ve seen far too many people more or less confined to their homes by pain. A lot of people suffering from chronic pain are above their ideal body weight or are outright obese. Some became heavy before their pain began—and typically gained more once pain became a problem—while others began gaining weight after their pain settled in.

In either case I’ve observed that the longer the pain lasts, the more weight is gained. Of course the added pounds set these people up for more problems down the line. For example, they may develop back pain that leads to even more inactivity and weight gain, and over the course of ten years that added weight may cause knee pain.

Decline in Balance

As a general rule, balance declines over time. Although this, in itself, is not a cause of pain, it can indirectly bring about pain. Poor balance is a major factor in limiting your walking tolerance: The more unsteady you feel, the less you’ll want to move. And the less you move, the weaker your muscles become and the more likely you are to develop arthritis, obesity, and heart disease. A lack of balance is also a major cause of falls, which in turn are a major source of injury in the elderly. Hip fractures that result from falls are one of the leading causes of hospitalization (three hundred thousand per year) and morbidity in the elderly.


Arthritis is the nation’s most common chronic health problem and is the leading cause of disability among those over age fifteen. Technically speaking, the word arthritis means “inflammation of a joint,” but while some forms of the disease cause a lot of inflammation, others trigger little or none. Broadly speaking, arthritis encompasses some one hundred diseases that attack the joints, from osteoarthritis to rheumatoid arthritis and from gout to ankylosing spondylitis.

In its various forms, arthritis afflicts some forty-six million Americans.

Chronic pain, obesity, and arthritis are locked in a vicious circle, with each able to make the others worse. It can go like this: You enter your forties with a little arthritis in your knees, you gain some weight as your metabolism slows, this puts more pressure on your knees and worsens your arthritis, you stop playing racquetball and cut back on your treadmill time because of the pain, now you’re burning even fewer calories, so you gain more weight, and so on.

Adding to the misery, in some forms of arthritis—including the most prevalent, osteoarthritis—an additional problem called glycation develops. During glycation, excess glucose circulating in the body binds to certain proteins and fats in the tissues, creating harmful substances called advanced glycation end products, or AGEs. Medical researchers believe that this glycation reaction causes some of the major detrimental changes of aging. Glycation “cross-links” proteins in the body, deforming them and making them less elastic and flexible. On the surface of the body, this cross-linking and deformation shows up as wrinkles. Inside the body, it causes numerous problems including hardening of the arteries, degeneration of the central nervous system, inflammation, and stiff joints. The joints become stiff because the cartilage, which cushions and protects the ends of bones, is made up of collagen, which is susceptible to glycation. In theory, the more sugar that binds to the proteins in the collagen, the stiffer the cartilage will get, and therefore the more painful it will be to move the joint.

Periods of elevated blood sugar increase the rate of cartilage glycation, so it’s important to keep blood sugar levels under control. You can use the glycemic index when planning meals to help you select your foods properly and avoid the harmful blood sugar spikes that encourage glycation.


Ten million Americans suffer from osteoporosis, and an additional thirty-four million are at greater risk of developing this disease that makes the bones fragile and increasingly likely to break. The disease process itself is painless; you often don’t know anything is wrong until a bone breaks. This doesn’t mean that all broken bones are the result of osteoporosis, but if you have the disease, your bones will break too easily. For example, if you have osteoporosis, a minor fall that would normally result in nothing more than a bruise might cause your hip to break.

Osteoporosis can affect any bone, but the most serious problems typically occur in the hips or spine. A broken hip can cause prolonged or permanent disability, with the patient confined to a wheelchair, while fractured vertebrae can cause spinal deformity and severe, long-lasting pain.

The disease can strike both sexes, although women are four times more likely than men to develop it. Risk factors that increase the odds of developing osteoporosis include the following:

  • Gender (being female)
  • Age (being older)
  • Ethnicity (Caucasian, Asian, or Hispanic/Latino are at greater risk than African Americans)
  • Certain diseases (including anorexia nervosa and rheumatoid arthritis)
  • Body type (being small and thin)
  • Family history (relatives with osteoporosis or a tendency toward broken bones)
  • Personal history (a tendency to break bones, history of skipping periods for women)
  • Sex hormone levels (postmenopausal or low estrogen for women, low testosterone and elevated estrogen for men)
  • Diet (inadequate intake of calcium and vitamin D, excessive intake of sodium, caffeine, and protein)
  • A sedentary lifestyle
  • Smoking
  • Drinking excessive amounts of alcohol
  • Using certain medications (including steroid medications and certain anticonvulsants)

There’s nothing you can do about some of these risk factors—you can’t change your gender, age, ethnicity or family history—but you can watch what you eat and make sure that you exercise, two of the best and easiest ways to prevent the disease. A good diet will provide the calcium, vitamin D, vitamin K, and other nutrients needed for strong bones, while regularly engaging in weight-bearing exercise will “stress” the bones and signal the body to keep them strong. It’s also a good idea to avoid excessive alcohol intake and smoking altogether.

Your Anti-Aging Plan

Change is an integral part of preparing for your pain-free future: Changing your exercise regimen, diet, and/or attitude can put you on the road to good health for years to come. Each individual change does not have to be huge: You don’t have to go from being a diehard meat-and-potatoes eater to a strict vegetarian or from an occasional stroller to a marathon runner. You only need a series of small changes to get started—and as you progress, you may find that you enjoy the results of your small changes and want to push them further.

The key elements of an anti-aging plan include proper nutrition and exercise; maintaining a healthy balance between muscle and fat mass; staying ambulatory with good balance; and keeping the mind sharp by stimulating it and keeping it clean with meditative exercises. Naturally you need to develop a strategy that speaks to your biggest needs, yet is doable enough to stay with for years to come.

Walking Tall

I have found the ability to stay ambulatory to be one of the keys to staying young. Over and over again, I’ve noticed that those who retain the ability to walk have much better “golden” years than those who do not. That’s why I consider the ability to walk to be a defining characteristic of graceful aging. Think about it: Standing and walking are necessary for buying groceries, visiting the neighbors, picking up the mail, cleaning the house, and tending the gardens.

As you go through your fifties, sixties, seventies, and beyond, maintaining your ability to “walk tall,” as I say to my patients, means being able to do all of these things. Remember: The less you are able to move and walk on your own, the smaller and smaller your world becomes and the less exercise you can tolerate. Vigorous exercise helps maintain the health of the heart, brain, and just about any other body part that relies on good circulation, so reduced exercise tolerance negatively affects physical and emotional health.

As these changes occur, we interact with far fewer people and become closed off from our communities, which creates a real sense of loss. Even my ailing grandmother, with all of her aches and pains, used to look forward to daily outings with my mom to the local bakery for coffee and human contact. In fact my other grandmother was famous for keeping her purse and coat next to the front door so she would be ready to leave in an instant with anyone who might be going somewhere. That’s why I believe that developing a plan to maintain as much weight-bearing capacity as possible, for as long as possible, should be on the top of anyone’s “How to Age Gracefully” list.

The first step toward maintaining the ability to walk tall is to consider how far or how long you’d like to be able to walk. One mile? For thirty minutes? For as long as possible? Are stairs and inclines important to you? The next step is to determine how much you can walk at present. If you are starting off below your target, you have some work to do. If not, if you can already meet your target, then you need to think more in terms of staying fit as you grow older. I say that because preserving your walking tolerance means more than just walking for exercise; it also requires focusing on things like keeping your joints flexible, balance intact, and muscles strong. Remember: Being a proficient walker when you are elderly can make the difference between this being a very rich and fulfilling period in your life or one marked by isolation and lost independence.

Other forms of exercise indirectly contribute to the maintenance of our walking tolerance. For those of us who don’t perform hard labor on a regular basis, a regular strength-training routine is necessary. It’s essential that we maintain the strength of our large muscles, like the pectoralis major and minor in the chest, quadriceps and hamstrings in the legs, as well as small muscles like the short fibers between the vertebrae in the spine and the small muscles in the hands. Keeping all your muscles strong greatly increases your chances of feeling good and being ambulatory at a time when your peers might be struggling just to get out of bed.

Free weights, machine weights, bands, and old-fashioned push-ups and pull-ups are all good strength-training exercises. And just thirty to sixty minutes of this type of exercise twice a week may be enough to prevent age-related decline in the large muscle groups. Focusing on large muscle groups alone, however, ignores the many other valuable muscles necessary for a strong, flexible, and active body. For example, there are dozens of small supporting muscles up and down the spine or in the hands and arms that are not engaged if you focus solely on weight training. These muscles also need to be strengthened and exercised if they are to help the body remain functional.

Yoga and Pilates exercises can help with this. Consider Downward Dog. Starting with the hands and moving down to the feet, it is amazing how many muscle groups get engaged in this posture. First of all, the fingers and hands are very active on the floor, which strengthens small muscles in the fingers, hands, and forearms that would likely never get used when lifting heavy weights. The complex muscle groups around the shoulders are active in helping roll the shoulder blades down the sides. As the spine is stretched, numerous muscles up and down the back help support this elongation. Next the pelvis, with its many layers of muscles, has to work to stay elevated. Below the pelvis, the hamstrings work to straighten the legs and support the body weight. Even the small muscles in the feet are activated for support and balance. This simple pose utilizes parts of the body that may be missed with exercises that just focus on specific large muscle groups.

In addition to buffing up the muscles, strength-training exercises also help prevent bone loss and osteoporosis by putting stress on the bones, which encourages the body to strengthen them in response. Of course the only way that exercise will pay off down the line is if you do it consistently over the course of many years. And that means you’ll need to find forms of exercise that are diverse, interesting, and most of all fun! There are all kinds of ways to exercise, so don’t limit yourself. Keep looking for ways to move your body that will be enjoyable—you’ll be much more likely to stick with an exercise program that gives you pleasure!

Maintaining and Improving Balance

Balance generally gets shakier with age, but there are plenty of things you can do to maintain and even improve it. Some examples include dancing, riding a bicycle, practicing yoga or tai chi, and doing Pilates (which improves core strength and increases trunk stability).

Simply walking or using exercise machines may not do the trick. To improve your balance you need to perform activities that require your nervous system to “practice” the many minute adjustments it has to make to keep you steady and force you to strengthen the muscles that keep your body stable as your perform various activities. Research suggests that exercise classes that offer a variety of movements will help reduce falls best, so it’s a good idea to take a class! Don’t take poor balance lying down! There are simple balance-building exercises you can do at home to get started. For example:

  • Stand on one leg for thirty seconds at a time.
  • Put your shoes on while standing up.
  • Sit down in a chair and get up again, without using your hands for either movement.
  • Practice heel-to-toe walking. With each step, land first on your heel then gently “rock” the foot forward until your weight is on the toe. You can put one hand on the wall as you walk to steady yourself, or if need be someone can walk beside you to help keep you steady.
  • Do leg lifts with the help of a chair. Stand tall holding onto the back of a secure chair. Raise one knee toward your chest, hold it there for a few seconds, then lower it. Now do the other knee. You can also raise each leg out to the side (without bending the knees), or raise your straightened legs behind you, one at a time, while still holding onto the chair. See if you can build up so that with each leg you are doing each of the three leg lifts ten times each.

Nutrition and Weight Management

Following the principles of an anti-inflammatory diet will serve you well in your journey toward painless aging. Avoiding spikes in blood sugar by choosing smaller but more frequent low-glycemic meals will reduce the amount of extra glucose floating in the blood. That means there will not be as much glucose to bind to cartilage through the process of glycation. Remember: Aging experts believe glycation is a major contributor to painful, degenerated joints.

Obesity causes pain directly by stressing the joints and indirectly by increasing the odds of developing a variety of other diseases that lead to pain. Obesity can also make it more difficult for you to move your body, which is another problem. I can’t say it enough: Staying healthy as you age depends a lot on maintaining a healthy weight and body mass index.

The anti-inflammatory diet helps prevent weight-related stress on the body by shifting caloric intake away from foods containing trans fats and high fructose corn syrup and toward rainbow foods that are plentiful in antioxidants and fiber. This shift invariably lowers total daily caloric intake, which is a must to counteract the metabolic slowing associated with aging. The abundance of antioxidants serves to clean up toxic waste that can build up in crucial tissues like the heart and brain. A steady flow of proteins during the day keeps important muscles groups fortified.

Although books, newspaper and magazine advertisements, television commercials, infomercials, and your friends may promote this or that fad diet, the truth is this: The best way to lose weight is to burn more calories than you consume. I know it’s not very exciting, but this means consuming fewer calories and increasing your energy output. As you age, your metabolism will naturally slow down, which means your body will burn fewer calories than when you were younger. Cutting out just one can of soda or one energy drink each day can reduce your daily caloric intake by 150 calories or more, while walking an additional 30 minutes can burn about 100 calories. That adds up to 250 fewer calories per day. Approximately 3,500 calories equals 1 pound, so at that rate you’ll lose 1 pound every 2 weeks.

Of course fad diets promise dramatic weight loss in a much shorter period. Unfortunately, while you may be able to lose a lot of weight quickly on a fad diet, studies show that chances are excellent that you’ll gain back all of the weight, plus a little more, within a year or so. The scientific truth is that most fad diets don’t work, and those that do only work for a brief period. Once you start eating “normally” again, you’ll regain the weight. Sensible, safe, and sound dieting, combined with moderate yet steady exercise, is the only weight control prescription that has stood the test of time.

Exercise Your Brain

An important part of aging gracefully involves preserving your mental faculties. I believe that chronic pain is a risk factor for declining cognitive function later in life. Why? Because the physiology of the stress response triggered by chronic pain has been shown to reduce brain function. For one thing, the chronic inflammation associated with stress and chronic pain is now known to be a major contributor to Alzheimer’s disease and other forms of dementia. In addition, chronic pain may encourage lifestyle habits that can increase the likelihood of developing dementia or Alzheimer’s disease. These include challenging our brains less often than we should, overmedicating, consuming a diet high in free radicals and oxidants, and engaging in too little aerobic activity.

It isn’t enough just to pay attention to the parts below the neck. Our brains and bodies need constant tune-ups so they will run smoothly in our later years. Fortunately there are things we can do every day that can contribute to good cognitive function today and down the line. These include the following:

  • Follow an anti-inflammatory diet. Let nature’s powerful antioxidants quell the damaging inflammatory mediators in your brain and body.
  • Engage in some form of vigorous exercise at least twice a week—walking counts! Aerobic activities such as walking and running stimulate the growth of new nervous system cells.
  • Exercise your brain by keeping it active. Spend more time reading, writing letters, going to museums and lectures, solving crossword puzzles and Sudoku, and playing games like chess and bridge and less time engaging in more passive pursuits like watching television, mindless Internet surfing, and other couch potato–type activities.
  • Keep learning. Never stop challenging your mind. Expose it to new things, like a new language or a new musical instrument. Don’t settle for the same television shows, Web sites, or newspapers over and over again. Make time to visit stimulating places and events like museums, concert halls, libraries, lectures, and discussion groups. It’s never too late to begin learning!
  • Love your neighbor. Thoughts and feelings of affection have been shown to promote the growth of new nervous system cells. I know it sounds corny, but embracing this philosophy leads to many happy returns, including a healthier mind. Clear the mind of excessive chatter through regular mindful practices such as meditation, prayer, or yoga.

Take stock of how you use your time each day. Are you performing activities that can stimulate your brain? If not, come up with alternative things to do to boost your brainpower.

Losing cognitive ability rapidly ages you. Even in its early stages, even with just a little memory loss, people feel embarrassed and begin to detach from their friends and family. Increasingly isolated, they can easily become depressed and anxious and lose interest in maintaining their health and in life in general as they withdraw into themselves. In other words, just a little loss of brainpower can set in motion events that can make you feel a lot older than your years and drain enjoyment from your life.

Prevention is the best antidote to dementia that we have. Help ward it off by following the tips above and be sure to socialize with happy, healthy people who are fun to be with. Social contacts matter! A recent study conducted by Harvard and University of California, San Diego found that happy people tend to hang around with other happy people, so happiness is apparently contagious. However, habits or conditions like smoking and obesity can also be contagious, so choose your companions wisely. Spend as much time as possible with happy, healthy people.

Stick to the Basics

It seems like we’ve covered a lot, but aging as painlessly as possible boils down to just a few basic principles:

  • Adhere to the anti-inflammatory diet.
  • Exercise muscles big and small to stay ambulatory.
  • Keep your weight under control (shoot for a body mass index within the normal range).
  • Maintain your balance.
  • Give your brain plenty of exercise.
  • Spend time with other happy, healthy people.

These six steps can all work together for your benefit. For example, if you consume a health-enhancing diet and exercise, you’re already working to keep your weight under control. And by taking an exercise class with a friend, you can remain strong and engage with others.

I urge you to mold this into your own personalized anti-aging plan; create a health portfolio that will serve you well for a lifetime. As you master each element of your plan, you’ll be surprised at how easy it is to do the next one.

You owe it to yourself to remain young and healthy, right up until you’ve reached a very old age. There are many things in this world that age well, including wine, cheese, and violins. Why shouldn’t you be one of them, too?

Excellent Anti-Aging Activities

Activities such as yoga, Pilates, tai chi, and qigong may be the perfect antidote to the aches and pains of getting older. They can help you age gracefully because they help you:

  • Exercise many muscles, including some that might otherwise be overlooked.
  • Improve muscular support to the spine and the joints.
  • Improve posture and balance.
  • Improve flexibility and prevent painful stiffness that might otherwise limit activity.
  • Improve core muscle strength and stability around the midsection, warding off low back pain.
  • Release stress and increase relaxation.
  • Promote good circulation throughout the body.
  • Stimulate the release of endorphins, the body’s natural painkiller.
  • Prevent osteoporosis.

The anti-aging activities noted here will go a long way toward helping you ward off the ill effects of aging and help you avoid the chronic pain that can occur as you mature.


Terumi Joki's picture

This is a huge topic. May be it's too long. Can be separate link for arthritis or osteoporosis etc.