Q. Is pain a necessary part of aging?

It is very difficult to avoid physical pain as you get older. However, as many people age, they complain less about pain. This phenomenon may be caused by a decreased sensitivity to pain. However, some believe that seniors don't moan as much as juniors because they tend to be stoics.

People have a variety of inborn pain thresholds. I have two granddaughters who are so different in their ability to handle pain that it is almost comical. I've seen one of them tumble off a bike, skin her knee and climb back in the saddle without a whimper. The other little girl will cry inconsolably over the smallest splinter.

The ability to withstand pain depends upon emotion, too. Athletes have played with broken bones because they were so pumped up by the action around them that they didn't know they'd been injured. Later, in the locker room, the pain kicked in.

Pain may be acute or chronic. Acute pain comes on suddenly and subsides after a short time. Chronic pain persists. Many seniors suffer from chronic pain, which has a variety of causes.

Pain affects as much as 65 percent of independent older adults and up to 80 percent of seniors in long-term care facilities. The following are some of the causes:

About 80 percent of older adults suffer from osteoarthritis, inflammation of the joints.

You get osteoarthritis when cartilage the cushioning tissue within the joints wears down. This produces stiffness and pain. You can get it in any joint, but it usually strikes those that support weight.

People with diabetes, a condition that affects almost 20 percent of Americans over the age of 60, often have circulatory problems that produce pain.

Gallstones, appendicitis, bowel obstruction, peptic ulcer disease, abdominal aortic aneurysm and gastroenteritis generate abdominal pain.

Spinal problems such as herniated disks, spinal narrowing and arthritis are the causes of back and neck pain, which is very common in older adults.

The chances of getting cancer increase as you age. Pain is a common symptom of all types of cancer.

Fibromyalgia is a syndrome characterized by chronic pain in the muscles and soft tissues surrounding joints. Patients over 60 frequently cite fatigue, swelling, headaches, anxiety and depression as their most severe fibromyalgia symptoms.

Headache is a common difficulty for seniors. Headaches unrelated to underlying diseases are classified in three different types: cluster, tension and migraine. Tension headaches are, by far, the most common type, affecting up to 90 percent of women and 70 percent of men.

Researchers believe more than 20 million people suffer from peripheral neuropathy. Neuropathic pain usually stems from nerve damage, which can be caused by diabetes and disorders of the kidney, liver and thyroid.

Pain in the face, mouth and teeth can be brought on by periodontal diseases, tooth loss, and medication side effects.

Chronic pelvic pain affects up to about 10 percent of women and can be related to a number of different conditions, including infection, uterine fibroids, kidney stones, and pelvic inflammatory disease (PID).

Complex Regional Pain Syndrome (CRPS) is an extremely painful condition that develops after an illness or injury.

When older people suffer from chronic pain, there are many complications. It can make them lose sleep, diminish their ability to function, lead them to be more dependent on others, dampen their appetite, isolate and depress them, and reduce physical activity, which can make them get out of shape and be more likely to suffer a fall.

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