For many adults over 65, pain can become somewhat of a constant. Nearly 40% of seniors report experiencing chronic pain, whether it’s in their back, knees, hips, or some other kind of musculoskeletal pain, such as osteoarthritis.

Frustratingly, chronic pain isn’t always easy to treat. But thanks to a new Medicare program called ACCESS, or Advancing Chronic Care with Effective, Scalable Solutions, Original Medicare beneficiaries now have another option for managing long-lasting pain.

ACCESS changes how some organizations are paid for chronic pain management, shifting the focus from how many visits you have to whether your health actually improves.

To understand why that’s important — and how Bold’s approach to chronic pain management can help — we spoke with Dr. Claire Hsing, DPT, a doctor of physical therapy and Bold’s Clinical Programming Manager.

In our conversation below, she shares key details about Bold’s personalized program for pain management, why pain neuroscience education is important to symptom improvement, and how to find out if you’re eligible for the program under ACCESS with no copay and no coinsurance.

Understanding chronic pain

What’s the difference between chronic pain and other pain? 

One way to think about it is chronic pain is pain that you experience at such a repeated and consistent level that it becomes more complex than a simple, acute injury, like a paper cut.

You can see a paper cut on your finger or hand, and you can directly associate that with the pain that you're perceiving. Chronic pain is on the other end of the spectrum: There’s more to it than a tissue injury.

The way that chronic pain is typically defined in a lot of circles is pain that exceeds 12 weeks or three months in duration. 

What is important, though, is to understand that it's more about pain that exists not just because of an inherent injury, but it's become more complex and typically harder to treat, just because of how long it has persisted for.

How do I know if I have chronic pain? 

In addition to your pain lasting for at least 12 weeks, you can think about the answer to this question as relating to how you’re pushed to solve the problem.

If you and your care team have already taken steps to address or uncover that underlying original injury, and you're still not meaningfully moving the needle of your experience of pain, that to me is a fair signal there's something else going on here that would be worth addressing with a chronic pain intervention.

What are some common symptoms of chronic pain? 

One thing that can show up is a lack of a bigger event or a reason for the pain. 

If you were to stub your toe into the wall, you wouldn’t be shocked when you felt pain in your foot. But you might associate chronic pain with an outsized amount of pain from a trigger that seems disconnected. For example, you might turn your head to look behind you and then have a big pain in your neck. That can be one way we commonly suggest that the pain is not originating in the tissue but is more related to the way we experience pain in the brain, process that experience, and ascribe importance to it. 

When should I talk to my provider about my chronic pain? 

You don’t have to wait to experience pain for 12 weeks to seek care. There's a really individual element of when to seek care that depends on your access to care. But once your pain starts to impede your day-to-day activities and quality of life, you should do something about it. If doing something about it requires modifications like moving less that could have long-term implications, you should seek guidance on how to manage that, such that you can continue to maintain your quality of life.

Treating chronic pain 

What are common interventions for chronic pain? 

There are two arms of interventions for pain. One is solving the problem right now. That might be lying down, using a hot pack or an ice pack, or taking an ibuprofen. These are relatively passive activities that might give you some short-term, immediate relief.

But that should be coupled with an intervention that is a little more active, a little more engaging, and is working toward a longer-term solution. That’s where therapeutic exercise and regular movement can be really helpful. 

Why is exercise helpful for managing and improving chronic pain? 

Think about the pipes in a house. If you had a leak, the first thing you’d do is shut off the water, then you’d go find and repair the leak. But you wouldn’t want to shut the water off indefinitely. That’s the short-term solution to stop the leak from, say, flooding your basement. But you need the water, and the longer you leave it off, the harder it becomes to operate normally in your home.

Movement for chronic pain is similar. We need movement in life, not just to have a high quality of life and be independent, but particularly for seniors. Our bodies function off movement. For example, the way blood, after delivering oxygen, comes back to the heart is via a mechanical pump from our legs. If you stopped all movement, there would be a high cost to your body.

The importance of pain neuroscience education 

What is pain neuroscience? 

Pain neuroscience calls back to the fact that pain is a really complex experience. Pain is not only the inflammation when you bump your knee and you see it swell up. Pain is a signal that goes to your brain, and your brain does some interpretation, and it makes meaning of that signal. At a very elementary level, pain could be a signal of danger: Don't hold onto that hot pan.

But that signaling and processing aren’t always perfect. If they were, we would have no chronic pain. The issue is that signal can be unreliable, and it can become increasingly unreliable as it is reinforced. Pain neuroscience teaches us that if you have an experience of pain to which you ascribe a lot of danger, then your future experiences will be perceived to be worse.

You can liken this to how people experience trauma. Two people with totally different histories could have the same objective experience and make very different meaning of it, and their experience of the psychological impact could be really different. Musculoskeletal pain follows a lot of those principles. 

What role does pain neuroscience education play in effective chronic pain management? 

Pain neuroscience education explores how that experience of pain is variable, not just based on what happened to your knee or your back or so on, but what meaning your brain is making of that signal from your knee or your back. This helps people understand that that signal can be faulty. 

What can I expect to learn through pain neuroscience education? 

The first part of pain neuroscience education is learning that pain can be a false messenger, that it’s happening in your brain. That may sound simple, but it isn’t always, especially if you’ve experienced chronic pain for prolonged periods of time. 

The next part relates more to actionable next steps. This is complex, and you’ll benefit from working closely with a great chronic pain practitioner. They’ll help you experiment with different mindsets and movement options to start addressing and adequately managing your pain.

Bold’s pain neuroscience education program covers the basics so that you have some guidance on where to start.

The new Medicare program for chronic pain

What is the Medicare ACCESS program for chronic pain, and why is it promising?

Medicare’s new ACCESS program gives seniors access to more consistent, technology-supported care for chronic musculoskeletal pain by changing the way healthcare providers are compensated.

Rather than a fee-for-service model, reimbursement is shifting toward an outcome-based model. Outcome-based compensation is based on the presumption that there is a higher goal when you go to see a provider, and that they will be compensated commensurately to their ability to achieve that goal.

This can incentivize practitioners to work as efficiently as possible. If I can get your back pain to a good place in one month versus six months, why would I take six months when I can take one month? And that's aligned with the goals of the patient, so that’s very promising.

I think it’s important to keep in mind that there are ethical considerations about an outcomes-based approach. For one extreme example, there isn’t an economic incentive to give meaningful care to people who aren’t expected to improve. Chronic pain is hard to manage. But we believe everyone is equally deserving of care and support. And this extends toward people across socioeconomic and racial and ethnic groups, because a lot of the determinants of long-term outcomes are related not just to care, but to secondary factors like resourcing, social determinants of health, and so on. 

How can technology help with pain management? 

Bold’s digital platform makes our pain management program more accessible and personalized. It helps take the guesswork out of what you should do today or what you can expect this week in your movement. Plus, we’ve designed it specifically with older adults in mind to help you engage with our platform, navigate it as easily as possible, and get the most out of our offerings.

Why Bold’s approach to chronic pain management is different 

What can I expect from Bold’s chronic pain program for Medicare?

Our chronic pain program was designed by physical therapists for adults 65 and up. You can expect movement instruction, pain education, and support from our clinical team.

You’ll check in every day for your movement recommendations, which adjust to your pain and preferences daily. We strive to meet people where they are. 

What’s different about Bold’s program? 

What’s unique about Bold is how much we’ve invested in seniors and their needs. A lot of thought went into our content curation. You’ll get movement recommendations at a much higher standard than if you found something to follow on social media or YouTube.

How is the program personalized based on my preferences or needs? 

There are two different elements of personalization. The first is about your movement preferences: Do you only feel safe exercising from a chair? Do you feel like you could stand or be on the floor? Do you have different equipment? Do you have certain trainers that you prefer to work with? These are all very important to habit formation and consistency.

Then, what we’ve been focusing on for chronic pain is day-to-day responsiveness to your current state. You can tell us how your pain is feeling on a given day, and our platform will give you something more or less challenging based on that feeling.

This way, we continue to reinforce the habit of engaging with our exercise platform, which in turn improves the likelihood that you’ll adhere to the program and experience improvement in your pain.

How to sign up for Bold for Chronic MSK Pain 

Start by checking if you’re eligible. A brief conversation with our team can help you figure out next steps.

Medicare members and referring providers can check eligibility and sign up at agebold.com/access or by calling (424) 414-7672. 

What to have ready for your eligibility check

Before your eligibility check, make sure you’re prepared to talk about:

• Where you feel pain
• When the pain started
• What activities are difficult because of the pain
• What activities or positions make the pain feel better or worse
• Any recent surgeries you’ve had
• Any other health conditions you live with

For providers and PTs: Here’s how to refer your patients to Bold 

If you're a physical therapist or other provider working with people living with chronic musculoskeletal pain, you can refer them to Bold's ACCESS program at agebold.com/access or by calling (424) 414-7672.

If you're interested in partnering with Bold, learn more here.