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By the AGS Expert Panel, The Management of Persistent
Pain in Older Persons
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Persistent pain is pain or discomfort that continues for an extended period
of time. Some conditions cause pain that may come and go for months or
years. In addition to physical discomfort, persistent pain can lead to
depression, disability, difficulty with walking and sleep problems. But,
there's good news! There are many treatments methods that can reduce pain.
Talk to your health care provider about your pain so he or she can provide
the help you need to feel better.
Is persistent pain a natural part of growing old?
No. Even though persistent pain is very common
in older people, it is neither normal nor healthy. It should not be
ignored or dismissed as "part of getting older."
How can I explain my pain to my health care provider?
Using a "Pain Diary" will help you explain
your pain to your health care provider. Here is what he or she needs to
know:
- Where it hurts;
- How often it hurts;
- How much it hurts;
- What the pain feels like (Does it burn? Is it sharp or dull? Does
it ache? Does it feel like pins and needles, or does it "shoot" through
a part of your body?);
- What (if anything) makes the pain go away;
- What causes the pain to worsen; and
- What medications or treatments have been tried, how well they have
worked, and what side effects (if any) the medication may have caused.
What is a pain diary and how can it help?
A pain diary is similar to a regular diary
or journal, except the entries focus on your experiences with pain. You
should record when you feel pain, the type of pain you felt (burning,
aching, etc.), the location of the pain, what you did to treat it, and
whether or not the treatment helped. A pain diary can help your health
care provider make a diagnosis and plan your treatment options.
Can I take over-the-counter medications for pain?
You should ask your health care provider.
Although over-the-counter pain medications are safe and helpful for mild
to moderate pain for a few days, severe pain or pain that lasts longer
than a few days may require a prescription drug. If you are already taking
prescription medications, you want to be sure that it will be safe to
take over-the-counter medications along with your prescription drugs.
What over-the-counter medicine is best?
- Acetaminophen (Tylenol, for example) may be the best choice for
mild-to-moderate pain caused by musculoskeletal conditions, such as
osteoarthritis or low back pain. But if you take acetaminophen for
more than a few days, you should talk to your health care provider.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin,
ibuprofen, or naproxen, may have more side effects in older people.
NSAIDs may also interact with other medical problems and prescription
medications. NSAIDs should be used carefully, especially when they
are taken at the highest dose or over a long period of time. It is
important to always tell your health care provider about all the over-the-counter
medications you use. The newest and safer form of NSAIDs, the COX-2
inhibitors, are not available over-the-counter, so you will need a
prescription from your health care provider. COX-2 inhibitors are
similar to the traditional NSAIDS, but are more selective in their
activity, relieving pain and inflammation while preserving the body's
ability to protect the stomach from ulcers and allow platelets (blood
clotting elements) to work normally.
Will I become addicted to pain killers?
Acetaminophen (such as Tylenol) and NSAID
drugs (such as aspirin, ibuprofen and the COX-2 inhibitors) are not habit-forming.
Opioid pain medicines (such as Vicoden, Percocet, Ultracet, Lortab, and
others, including morphine) can cause unpleasant symptoms if stopped suddenly.
Addiction to opioid pain medicines is very rare in older adults; the risk
has likely been overstated and may keep many doctors and their patients
from receiving benefits from opioids when other analgesics have not been
effective in relieving pain.
Are there side effects from medicines that relieve
pain?
Any medicine - whether over-the-counter or
prescription-may cause side effects.
- Acetaminophen is an ingredient in many over-the-counter and prescription
medications. If you take several medications that contain acetaminophen,
you may be taking too much. Be sure your health care provider knows
all medications you are using.
- When used for a long period of time, traditional NSAIDs, such as
ibuprofen and naproxen, can cause indigestion, stomach ulcers, easy
bruising, or bleeding. These older drugs and the newer COX-2 inhibitors
can cause kidney problems, especially in older patients. Although
usually safe, these drugs can worsen high blood pressure or contribute
to heart failure in patients who are at risk for these problems. That
is why it is important to stay in touch with your health care provider
so that he or she can guide and monitor you.
- Opioid medications may cause initial drowsiness and usually cause
constipation (which can be prevented and treated), but the body generally
adapts to many of their side effects quickly. Although they can be
habit forming, these medications may be the best choice for you, since
their side effects are less serious than those caused by traditional
NSAIDs, or untreated, debilitating pain.
Remember, medicines are intended to help you! If you have any questions
or concerns about side effects, talk to your health care provider. If
you have any side effects, tell your health care provider. There may be
other medicines or treatments that might work better for you.
My health care provider suggests that I take antidepressants
for my pain. Does this mean the pain is just in my head?
No! Research has shown that some antidepressant
medications can help relieve some types of persistent pain. Other medicines
known to help certain kinds of pain include anticonvulsant drugs, such
as Tegretol (carbamazepine) and Neurontin (gabapentin), and local anesthetics,
such as lidocaine. These drugs seem to be most effective against persistent
pain associated with nerve injuries and nerve diseases (neuropathic pain).
Ask your health care provider to explain the medications you are taking.
What can I do besides taking medications?
There are many other treatments for pain.
The more you know about your pain, the more you can do to control it.
There are patient education programs that can teach you about pain and
how to cope with it. Ask your health care provider about programs in your
area. Exercise is also extremely important. Ask about appropriate physical
therapy, exercise, or fitness programs that can improve your physical
strength, range of motion of your joints and limbs, walking stability,
and endurance. Other non-drug treatments, such as the use of heat, cold,
acupuncture, and transcutaneous electrical nerve stimulation (TENS), may
help some people. It is important to ask your health care provider about
the usefulness of these and other treatments for your specific problem.
What if my pain is not relieved?
Don't give up! Ask your health care provider
for a referral to a pain management center. Your local hospital may offer
patient education programs and support groups for patients and family
members. Some persistent pain problems are extremely complex and require
a team of specialists to diagnose and manage them. Although you may not
get complete relief from all pain, much can be done to control or manage
most persistent pain problems.
Where can I get more information about persistent
pain management?
- The AGS Foundation for Health in Aging
Eldercare At Home, Chapter 11
www.healthinaging.org
The Empire State Building
350 Fifth Avenue, Suite 801
New York, NY 10118
(800) 563-4916
- National Chronic Pain Outreach Association (NCPOA)
7979 Old Georgetown Road, Suite 100
Bethesda, MD 20814-2429
(301) 652-4948
- American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677
(916) 632-0922
www.theacpa.org
- American Pain Society
4700 W. Lake Ave.
Glenview, IL 60025
(847) 375-4715
www.ampainsoc.org
- Arthritis Foundation
1330 W. Peachtree
Atlanta, GA 30309
(800) 283-7800
www.arthritis.org
- National Headache Foundation
5252 North Western Avenue
Chicago, IL 60625
(888) NHF-5552
www.headaches.org
AGS Panel on Persistent Pain in Older Persons. The Management of Persistent
Pain in Older Persons. American Geriatrics Society. J Am Geriatr Soc
2002; 50: June supplement.
Production of this brochure has been supported by an unrestricted grant
from McNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC,
Inc.
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