Aging & Health A to Z

Pain Management

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 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 healthcare professional will need to treat the pain with a variety of strategies (a multidisciplinary approach) and it may take longer to notice results.  

Drug Treatment/Medications

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.

Acetaminophen
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 doctor’s recommendations. You must use great 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, which should be considered only for short-term pain relief, includes non-prescription (aspirin, ibuprofen) or prescription drugs (naproxen, diclofenac).  They may cause bleeding in the stomach and intestines, and have other serious side effects (such as kidney damage,cardiac risk) that can limit their usefulness in many older patients.  Women over the age of 85 are at particularly high risk of bleeding.

Opioids
The opioid (narcotic) medications (only available by prescription) are very helpful for moderate to severe pain, including cancer pain, particularly in older adults. One great benefit of this group of drugs in older people is that they do not damage important organs like the kidney or liver, even at high doses. However, they do have some side effects that are usually manageable, but that sometimes limit their use, such as:

• Nausea and vomiting
• Constipation
• Sedation, fatigue, sleepiness
• Memory disturbances, confusion
• Itching.

Most of the side effects will go away after a few days, except for constipation.  To prevent this problem, laxatives and stool softeners should always be taken with opioids.  Although there have been concerns about addiction to opioid medications in the past, this is usually not a concern when they are used for pain control in older adults (unless there is a history of substance abuse in self or family history). Opioids are among the most well-understood and manageable pain medications available. In the vast majority of patients, the desire for the opioid ends as soon as the pain goes away. Stopping opioids abruptly can lead to withdrawal symptoms that occur because of physical dependence to the medication. The opioid is withdrawn gradually and there are no residual effects

Adjuvant Medications
A variety of other products, often used for other purposes (for example: treating depression, 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 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 he or she feels 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.

Non-Drug Therapies

Nonpharmacologic Approaches
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,pet therapy
• Hot or cold skin applications
• Relaxation techniques: meditation, deep breathing exercises, yoga, massage
• Exercise and physical therapy (individualized for the needs and capabilities of each patient)
• TENS (transcutaneous electrical nerve stimulation) (electrical impulses through skin)
• Cognitive-behavioral therapy (such as self-hypnosis, coping strategies)

Monitoring

Your healthcare professional should schedule regular follow-up visits to  keep track of the effectiveness of your treatment approach and may involve trying different medications or nondrug 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.

Updated: March 2012
Posted:  March 2012