Chronic Pain in the Elderly: How to Recognise It and What Families Can Do

Maria, 78, had stopped going on the park walks she used to love. Her son thought it was simply tiredness or a lack of motivation. It was only weeks later that he learned the truth: his mother was suffering from intense knee pain, but had said nothing. "I don't want to be a burden," she finally confided, eyes cast downward. Maria's story is not unique — it is the reality of millions of elderly people who endure pain in silence, convincing themselves that this is simply "how things are in old age".

Chronic pain in older adults remains one of the most underappreciated issues in home care. More than half of elderly people with persistent pain do not report it accurately to their doctors or family, and the consequences extend far beyond physical discomfort: social isolation, depression, loss of independence, and a dramatic decline in quality of life. For families, learning to recognise the invisible signs of pain and responding with both empathy and concrete action can completely transform the life of their loved one.

In this article, we will explore why chronic pain so often remains hidden, how to identify the subtle signals that a loved one is suffering, and — most importantly — what you can do in practical terms to help them live more comfortably and with greater dignity.

Contents

1. Why chronic pain so often remains hidden
2. The invisible signs: recognising pain without words
3. Common types of chronic pain in older adults
4. What families can do in practice: practical tools
5. Common mistakes that worsen suffering
6. How to communicate effectively with the specialist
7. Frequently asked questions

Why chronic pain so often remains hidden

Chronic pain in older adults is a complex phenomenon, often invisible to those around them. Unlike acute pain — which signals an emergency and prompts an immediate response — pain that persists for months or years becomes part of the background, normalised and concealed. Studies show that approximately 65–70% of older adults with chronic pain do not report it fully to their doctors, and within the family context that figure is even higher.

The reasons for this silence run deep, rooted in emotion and culture. Many older people were shaped by a generation that valued stoicism and feared "troubling" others. They worry that if they speak about their pain, they will become a burden to the family or be seen as weak. Another major factor is confusing pain with normal ageing — many elderly people genuinely believe that "this is just how it is at my age" and that pain is inevitable, so why mention it at all?

Factors that contribute to concealing pain

• Fear of diagnosis — the worry that the pain might indicate something serious they would rather not know about
• Previous negative experiences — doctors who dismissed their complaints, or treatments that did not work
• Mild cognitive decline — difficulty in accurately describing the intensity or location of pain
• Depression — which reduces motivation to seek help and amplifies the perception of pain
• Social isolation — the absence of someone with whom they can speak openly about their health

Understanding these deeper causes is the first step towards more compassionate care. When a family understands that silence does not mean an absence of pain — but often quite the opposite — they can adjust their approach and create a safe space for honest conversation.

The invisible signs: recognising pain without words

The body speaks even when words are absent. For carers and family members, learning to read the non-verbal language of pain is essential — particularly when a loved one does not verbally communicate their discomfort. Geriatric research has identified clear behavioural patterns that signal physical suffering, even in people with advanced dementia.

Careful observation of subtle changes in behaviour can reveal far more than direct questioning. An older person living with chronic pain may never complain, yet their body will send clear signals to those who know where to look.

Facial and postural signs

• Tense facial expressions — furrowed brows, tightly shut eyes, pressed or bitten lips
• Intermittent grimacing — particularly during movement or in certain positions
• Protective posture — guarding one part of the body, leaning to one side, avoiding certain movements
• Muscular rigidity — raised shoulders, clenched fists, a tense body

Changes in behaviour and activity

Chronic pain gradually transforms everyday behaviours. An active older person who suddenly becomes withdrawn, refuses activities they once enjoyed, or avoids certain movements is sending clear signals. Other indicators include:

• Reluctance to move — avoiding stairs, resistance to getting up from a chair, a laboured gait
• Unexplained agitation — unable to find a comfortable position, restlessness in bed, constantly shifting position
• Changes in sleep — frequent night-time waking, difficulty falling asleep, extreme daytime fatigue
• Increased irritability — disproportionate reactions, social withdrawal, loss of interest in hobbies
• Changes in eating habits — loss of appetite or sudden shifts in food preferences

It is important to observe patterns over time, not just isolated moments. A simple diary in which you note when these behaviours occur can reveal correlations — for example, increased agitation following certain activities or at particular times of day.

Common types of chronic pain in older adults

Not all pain is the same, and understanding the specific type of pain your loved one is experiencing can help you adapt their daily care and communicate more effectively with the doctor. Each type of pain has its own characteristics and requires a different approach.

Joint pain

This is the most common form of chronic pain in older adults, caused by osteoarthritis, rheumatoid arthritis, or other degenerative conditions. It manifests as pain on movement, morning stiffness (particularly in the first 30–60 minutes after waking), visible swelling, and a reduced range of motion. In terms of daily care, this means:

• The need for gentle warm-up exercises before activities
• Avoiding overloading the affected joints
• Using assistive devices (a walking stick, a walking frame)
• Adapting the environment to reduce the need for painful movements (higher chairs, grab rails)

Neuropathic pain

This results from nerve damage and is common in diabetes, shingles (herpes zoster), or following a stroke. It is described as a burning sensation, tingling, electric shocks, or a painful numbness. It is less predictable than joint pain and can be triggered even by light touch. In daily care:

• Pay attention to the texture of clothing and bedding (some fabrics can cause irritation)
• Protect sensitive areas from extreme cold or heat
• Avoid prolonged pressure on affected areas
• Monitor the feet closely in cases of diabetic neuropathy

Muscular and back pain

This can stem from poor posture, muscle weakness, contractures, or spinal conditions. It presents as a deep, constant or episodic pain, often worsened by certain positions. Implications for care include:

• The importance of an ergonomic bed and chair
• Avoiding prolonged periods in the same position
• Gentle massage or hot/cold applications (on medical advice)
• Gentle stretching and muscle-strengthening exercises

Correctly identifying the type of pain requires a professional medical assessment, but your observations about when, how, and where the pain occurs are essential for both diagnosis and treatment.

What families can do in practice: practical tools

Once you have recognised the presence of chronic pain, the next step is concrete action. The family plays a crucial role not only in emotional support, but also in the active management of pain. Here are the practical tools that can make a real difference to your loved one's comfort.

The pain diary: a powerful ally

One of the most valuable tools is the pain diary — a simple record that helps both the family and the doctor understand patterns. It need not be complicated; a notebook in which you record daily:

1. Pain intensity (on a scale of 1 to 10, or using facial expression images for those with cognitive difficulties)
2. Location — exactly where it hurts
3. Time of day — is it worse in the morning? In the evening?
4. Activities before or during the pain — what was the person doing when the pain appeared?
5. What relieved the pain — rest, movement, heat, medication?
6. Impact on activities — what could they not do because of the pain?

This diary becomes a precise map that allows the doctor to identify causes, adjust treatment, and evaluate the effectiveness of interventions. After 2–3 weeks of monitoring, patterns become clear.

Adapting the physical environment

Simple modifications at home can significantly reduce daily pain and prevent it from worsening. Think of the environment as a partner in managing pain:

• In the bedroom — a firm but comfortable mattress, supportive pillows for painful areas, the bed adjusted to the right height to make getting up easier
• In the bathroom — grab rails next to the toilet and bath, a shower seat to avoid prolonged standing, non-slip mats
• In the living room — chairs with straight backs and an appropriate seat height, accessible tables that don't require bending, good lighting to prevent falls
• On stairs — handrails on both sides, visible markings on steps, and possibly a stairlift or stair chair

Communicating effectively with the doctor

It is essential to consult a doctor for any chronic pain — do not attempt to manage it alone. To make the most of the appointment, prepare in advance:

• Bring the pain diary with concrete data
• Note all medications and supplements being taken (including over-the-counter ones)
• Describe the impact of pain on daily life, not just its intensity
• Ask specific questions: "What treatment options are available?" "What are the side effects?" "When should we come back if there is no improvement?"
• Ask for clear explanations about how to administer the treatment and what warning signs to look out for

Do not accept vague responses or dismissive attitudes. Chronic pain can and should be treated — persevere until you find a doctor who listens and puts together a personalised treatment plan.

Common mistakes that worsen suffering

With the best of intentions, many families make mistakes that paradoxically increase their loved one's suffering. Recognising these pitfalls is crucial to avoiding a deterioration of the situation.

Minimising and ignoring

The most common mistake is minimising complaints — "Oh, come on, it's normal at your age" or "Others have worse pain and don't complain". These reactions, even when they come from a desire to reduce anxiety, send the message that the pain doesn't matter and that the person shouldn't mention it. The result? Withdrawal into silence and amplified suffering.

Equally problematic is completely ignoring non-verbal signals. When you notice behavioural changes but choose not to investigate — "they're probably just tired" — you risk missing important windows for early intervention.

Uncontrolled self-medication

Another major and potentially dangerous mistake is administering medication without medical advice. Even over-the-counter medications (anti-inflammatories, analgesics) can have serious side effects in older adults: gastric problems, interactions with other medications, and impaired kidney or liver function.

• Never increase the dose without the doctor's approval
• Do not combine medications "because one alone isn't enough"
• Do not use old prescriptions or medication left over from previous treatments
• Do not rely on neighbours' advice or "miracle remedies" found online

Always consult a doctor before making any change to the treatment plan. Chronic pain requires professional management — what works for someone else may be ineffective or even dangerous for your loved one.

Overprotection and immobility

Out of a desire to protect, many families fall into the opposite trap: complete immobility. "Sit down, stop moving, you'll hurt yourself" seems logical, but the absence of movement leads to muscular weakness, increased joint stiffness, and — paradoxically — more pain in the long run. Gentle, adapted, and supervised movement is often an essential part of treatment.

How to communicate effectively with the specialist

The relationship with the doctor is the cornerstone of chronic pain management. Clear, structured, and persistent communication makes the difference between a treatment that works and one that does not.

Prepare for the consultation as you would for an important meeting. Write down your questions and concerns in advance. Do not rely on memory in the consulting room — the stress of the appointment may cause you to forget exactly what you wanted to ask. Prioritise your questions: start with the most pressing concerns.

Essential information to communicate

• The full history of the pain — when it started, how it has developed, what triggered it
• Previous treatments tried — what worked, what did not, what side effects occurred
• Functional impact — what activities they can no longer do, how it affects sleep, mood, and socialising
• All medical conditions — even those that seem unrelated to the pain
• Realistic expectations — what they hope to achieve from the treatment

Do not be afraid to seek a second opinion if you feel the pain is not being taken seriously, or if the treatment is not working after a reasonable period. Specialists in geriatric medicine, algology (pain medicine), or physiotherapy are valuable resources.

Establish a clear follow-up plan: when you will return for assessment, what warning signs warrant an urgent appointment, and how to contact the doctor between appointments if problems arise. A good treatment plan always includes monitoring and adjustments — not just a prescription and "see you in six months".

Frequently asked questions

How do I know whether the pain warrants a visit to the doctor or is something minor?

Any pain that persists for more than a few weeks, interferes with daily activities, worsens progressively, or is accompanied by other symptoms (fever, weight loss, weakness) requires a medical assessment. Do not wait until it becomes unbearable — early intervention prevents complications.

My loved one refuses to see a doctor about their pain. What should I do?

Try to understand the reason for the refusal — is it fear, previous negative experiences, a sense of being a burden? Approach the subject with empathy: "I'm worried about you and I want you to feel well. Let's go together — I'll be right there with you." If they continue to refuse, suggest a "routine" appointment, where you can separately mention the concerns you have observed to the doctor.

Can I use natural or alternative remedies for chronic pain?

Always consult a doctor first before introducing any remedy, even if it seems natural or harmless. Some supplements interact with prescribed medications. Complementary therapies such as physiotherapy, acupuncture, or massage can be beneficial, but they should be integrated into a comprehensive, medically approved plan — not used as the sole treatment.

How often should the pain diary be updated?

During the initial assessment phase, record entries daily for 2–4 weeks to identify clear patterns. Once a treatment is established, you can reduce the frequency to a few times a week, increasing it again when changes occur or before appointments. It does not need to be perfect — consistency matters more than exhaustive detail.

Can chronic pain and depression be linked?

Absolutely. Chronic pain significantly increases the risk of depression, and depression amplifies the perception of pain — it is a vicious cycle. If you notice social withdrawal, loss of interest in enjoyable activities, or changes in sleep or appetite, speak to the doctor about having mental health assessed. Treating both conditions simultaneously yields far better results.

What should I do if the prescribed medication is not working?

Do not abandon the treatment without consulting the doctor, and do not increase the dose on your own. Contact the doctor to discuss the situation — the dose may need adjusting, the medication may need changing, or additional forms of therapy may need to be introduced. Managing chronic pain often requires trial and adjustment before the optimal combination is found. Persistence and open communication are key.

Chronic pain in older adults is not an inevitable sentence, but a challenge that can be managed with understanding, attentiveness, and coordinated action. Through empathetic observation, open communication, and collaboration with healthcare professionals, your family can transform the quality of life of your loved one. Start today: observe, truly listen, and take action. If you would like to provide professional and compassionate care for your loved one, speak with a geriatric specialist or contact services specialising in home-based elderly care, who can offer personalised support and continuity in pain management.

This article is for informational purposes only and does not replace medical advice. For specific situations, please consult a specialist.