Aging & Health A to Z
Care & Treatment
Once your pain has been properly evaluated you can begin treatment. It is important to set goals for treatment and evaluate benefits and risks of your treatment options. For example, you may be willing to be slightly sedated/sleepy for a couple of days to have pain controlled. Or you may be willing to have some pain to be able to think clearly and talk with others. Sometimes, the treatment will work quickly and you will experience instant pain relief. In other cases, your primary care provider will need to treat the pain with a variety of strategies including seeing different healthcare professionals (a multidisciplinary approach) and it may take longer to notice results.
There are many safe and effective medicines to treat pain in older adults. Since every individual responds differently to pain medications, it may take a trial of more than one type to achieve good pain relief.
Older people often have complicated medical histories that have to be considered when choosing a pain relief medicine. For this reason, your doctor will usually start with a low dose of a pain drug and slowly increase the dose until you are feeling better in order to avoid side effects.
This is usually the first medication your doctor will recommend for mild-to-moderate pain, especially if you are having joint, muscle, or bone pain. However you must use it cautiously and remember that acetaminophen is added to many cold and flu preparations. Older people with certain conditions should take a lower maximum daily dose, so follow your provider’s recommendations. You must use caution with acetaminophen if you have any of the following conditions:
- Liver disease
- Severe kidney disease
- A history of alcohol abuse
Nonsteroidal anti-inflammatory Drugs (NSAIDs)
This class of medications includes non-prescription (such as aspirin, ibuprofen, naproxen) or prescription drugs (such as diclofenac). They may cause bleeding in the stomach and intestines, and have other serious side effects (such as kidney damage or cardiac risk) that can limit their usefulness in many older patients. Women over the age of 85 are at particularly high risk of bleeding. The U.S. Food and Drug Administration (FDA) especially cautions against combining ibuprofen and aspirin.
Opioid medications (also called narcotics) are only available by prescription and can be helpful for moderate to severe pain, including cancer pain. However, they do have some side effects that are important to be aware of. These include:
- Sedation, fatigue, sleepiness
- Memory disturbances, confusion
- Increased risk of falls
- Potential for addiction
Some side effects will often go away after a few days. To prevent constipation, laxatives and stool softeners should almost always be taken with opioids.
Many older adults are reluctant to take opioids out of fear of getting addicted. Although addiction is a legitimate concern, it is thought to be uncommon in older adults, and many older adults with pain get substantial relief from opioid medications. Opioids can increase risk of falls. People who have had falls, and therefore are at higher risk of future falls, should be particularly careful about using opioids. For people who have been taking opioids for a while, stopping opioids abruptly can lead to withdrawal symptoms. As a result, if someone has been taking opioids for a while, the dose should be slowly reduced rather than stopping the drug all at once.
A variety of other products, often used for other purposes (such as treating depression or seizures) provide good pain relief for many people. These include the following:
- Lidocaine: a topical agent (applied directly to the skin) available as a cream or patch
- Capsaicin: a topical agent derived from hot peppers available as a cream or patch
- Antidepressants: taken at doses adjusted to individual response, which may be different than for treating depression
- Anticonvulsants may be effective for some people with nerve pain
- Corticosteroids: injected directly into joints, tendons, or muscles or taken orally and helpful for soothing inflamed tissues
Patient-controlled Pain Relief
This approach is often effective for people with chronic pain and offers the psychological benefit of control over pain relief. A handheld pump or trigger mechanism allows the patient to administer the pain medication when they feel the need. The medicine is administered through an intravenous line. Often, patients feel more in control of their pain and actually use less medication when it is self-administered this way.
A number of non-drug strategies, used alone or in combination with drug therapy, have been proven to alleviate pain, and may reduce the need for medications. These approaches include:
- Diversions such as music, story-telling sessions, television, andpet therapy
- Hot or cold skin applications
- Relaxation techniques such as meditation, deep breathing exercises, yoga, and massage
- Exercise and physical therapy (individualized for the needs and abilities of each patient)
- TENS (transcutaneous electrical nerve stimulation)treatment which sends mild electrical impulses through the skin
- Interventional pain management (for example, injection of a temporary local anesthetic or pulsed radiofrequency for pain related to nerve injury)
- Cognitive-behavioral therapy such as self-hypnosis and coping strategies
When possible, caregivers should be included in the strategies. Family members may be able to use safe and simple methods to increase your comfort and reduce distress. For example, caregiver instruction in touch and massage can offer family members or other caregivers a way to enhance their self-confidence and satisfaction in caregiving, while helping to decrease your pain, depression, and other symptoms.
For older adults with advanced illness who are bedbound, regular repositioning, passive range-of-motion exercises, and gentle massage are key interventions.
Your healthcare provider should schedule regular follow-up visits to keep track of the effectiveness of your treatment approach and may involve trying different medications or non-drug treatments. The follow-up should make sure that any troublesome side effects are controlled. Medication dosing may also need to be monitored and adjusted. You may need periodic laboratory tests to make sure that your body is coping well with your drug treatment.
Do not hesitate to contact your healthcare provider if your pain remains unrelieved or you are experiencing any side effects.
Updated: March 2017
Posted: March 2012