Specific Considerations in dealing with an Aging Population
By James Dowd
For more than 40 years, Dr. Moacir Schnapp has built a medical career focused on pain management. And now that Schnapp is part of the senior demographic he has treated for decades, the Memphis neurologist is even more aware of the challenges – and opportunities – facing aging patients and the medical professionals who treat them.
“When I began my career it was rare to see a lot of patients coming to us who were over 75, but seniors are a steadily growing population,” Schnapp said. “Back then, families tended to keep elderly relatives at home because there was a mindset of just accepting chronic pain as part of the aging process. Now we see patients every day who are 90 and driving and independent, and many find that pain management allows them to remain active and functional and that is an enormous step forward in our field.”
Schnapp traces his interest in pain management to the late 1970s when he was nearing completion of a residency in neurology in Brazil. After earning his medical degree from the University of São Paulo, Schnapp came to Memphis for a fellowship in pain management at the University of Tennessee Health Science Center College of Medicine.
Schnapp remembers that in that era there were relatively few clinics that specialized in pain treatment, but there was one in Memphis that captured his attention. Following a stint back in Brazil as a medical director and associate professor at his alma mater, Schnapp returned to Memphis and joined Dr. Kit Mays in a practice dedicated to multidisciplinary pain management.
“I was always fascinated by neuropsychiatry, studying neurotransmitters and the basis of psychiatric matters and mental health, and that led me to a career in neurology,” Schnapp said. “Pain has always been puzzling, but when I was in medical school there seemed to very little interest in it within the larger medical community. I remember reading a major oncology book from that time and even though it was more 600 pages, only a few pages were devoted to pain.”
Many gains have been made in pain treatment in the last half-century, Schnapp said. When he first began practicing, doctors tended to be more conservative in treating cancer patients for pain out of a concern for potential drug dependency and the possibility of overdosing.
Determined to change the landscape, Schnapp and Mays established the pain management clinic Mays & Schnapp, which has become one of the leading pain clinics in the nation. The clinic is certified in all areas of adult pain management and rehabilitation by the Commission on Accreditation of Rehabilitation Facilities (CARF).
“There is an art to pain management and there are dozens of ways to manage pain and get comfort that benefit patients,” Schnapp said. “Patients often come to our office and they are afraid because they are in pain. The first thing they need is information delivered in a caring way because knowing what you have is the first step in determining a path for pain relief, just as knowing what you do not have can offer comfort because of the peace of mind that comes with that knowledge.”
Senior adults constitute a growing segment of his practice, Schnapp said, and that population comes with unique treatment challenges that do not usually affect younger patients. Older generations tend to be more wary of pain medication, due in no small part to the opioid epidemic. Cultural and societal stigmas also play a role.
“Older patients grew up in an era when you just dealt with pain, you didn’t get treated for it,” Schnapp said. “I often have to convince patients to take their medications regularly and I emphasize that the small dosages are to help them manage pain, not to get high.”
Increasing life expectancies have dramatically changed the approach to pain management, Schnapp said. A couple generations ago, patients over age 65 typically slowed down and did not expect to live well beyond 80. However, as Baby Boomers continue to remain active and vibrant, many patients in their sixties can expect to live for several more decades.
The key to pain management for seniors, Schnapp said, is focusing on quality rather than quantity of years remaining. Studying a patient’s cardiovascular function along with personal or family history of cancer or strokes or other diseases helps determine treatment.
“If we know that patient will likely be alive 30 years from now then pain treatment is markedly different from patient who may have only two years to live,” Schnapp said. “Our role is to help them be as functional as possible with their time remaining.”
Age-related arthritis is one of the most common conditions Schnapp sees. Treatments may include cortisone shots and nerve blocks to allow patients to engage in activities they love such as gardening and knitting and woodworking.
And while medications, including narcotics, are often helpful for helping seniors deal with pain issues, Schnapp stresses the need for physical therapy as part of a sustainable treatment program.
“Older patients have multiple pathologies and all contribute to pain, so it’s imperative that we know every medication they’re taking to understand if there are any underlying conditions that could be attributed to medications interacting with each other,” Schnapp said. “The combination of physical therapy with medication is important because it leads to increased mobility and flexibility, which in turn helps reduce pain and allows patients to remain active longer.”
In addition to pain management treatment and physical therapy, Schnapp encourages seniors to pursue healthy lifestyles. And the obvious cautions – stop smoking, watch alcohol and salt intake – still apply because advanced as the medical field has grown, there is no magic pill to cure everything.
“I’ve been watching for a great substitute for opiates since 1979, but so far there hasn’t been anything and I don’t see anything in the near future to change that,” Schnapp said. “Part of my job is to convince people to take charge of their health and stay active through activities such as Yoga or Pilates. I pass part of the onus of pain relief onto them because if I have to do everything for them then the treatment will fail.”