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AGS Expert Panel, The Management Of Chronic Pain in Older Persons
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Chronic pain is pain or discomfort that lasts for a long period of time. The pain can come and go for months or years. Pain can keep people from being happy with life. It can cause depression, disability, and problems with walking and with sleep.
Yet, there is good news! There are many treatments and methods that can help. Talk to your doctor or health care provider about your pain. Your own report of your pain is the only way your health care provider can know how you feel.
Q. Is chronic pain just part of growing old?
A. No. Pain is very common in older people but it is not normal nor healthy. It should not be ignored or said to be a "part of getting older."
How can I explain my pain to my health care provider?
A. Using a "Pain Diary" will help you tell your pain to your doctor or 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 medicines or treatments have been tried, how well have they worked, and what side effects (if any) they caused.
Q. What is a pain diary and how can it help?
A. A pain diary is a journal or record of your pain. You can write down when you felt pain, what type of pain you felt (burning, aching, etc.), the location or area of the pain, what you did for the pain, and how it may or may not have helped. A pain diary can help your doctor or health care provider find a cause for your pain and a plan of care.
Q. Can I take over-the-counter medicine for pain?
A. Ask your health care provider. Over-the-counter pain medications are safe and helpful for mild-to-moderate pain for a few days. For severe pain or pain that lasts longer than a few days, you should talk to your health care provider. If you are already taking prescription medicines you want to be sure that it will be safe to take over-the-counter medications along with your prescription drugs.
Q. What over-the-counter medicine is best?
A. Acetaminophen (Tylenol, for example) may be the best choice for mild-to-moderate pain caused by muscle or boneconditions, such as osteoarthritis or broken bone. 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 health problems and medicines. NSAIDs should be used very carefully especially if you have heart problems or stomach bleeding. It is important to always tell your health care provider about all the medicines you use including over-the counter.
Q. Are there side effects from medicines that help pain?
A. Any medicine - whether over-the-counter or prescription -- may cause side effects.
- Acetaminophen is an ingredient in many over-the-counter and prescriptionmedicines . If you take several medicines that contain acetaminophen, you can get too much. Be sure your health care provider knows all the medicines you are taking.
- The traditional NSAIDs, like ibuprofen and naproxen, when used for a long period of time, can cause problems such as indigestion, stomach ulcers, easy bruising, or bleeding. NSAIDS can make kidney function worse, especially in older People. Although usually safe, these drugs can make high blood pressure worse or add to heart failure in patients who are at risk for these problems. NSAIDS should not be used by patients with kidney disease or those with a high risk of stroke or heart attack, except in "baby aspirin" doses. It is important to stay in touch with your doctor or health care provider so that he or she can guide and watch you.
- Opioid medicines can cause drowsiness and usually do cause constipation. These medications may be the best choice, since their side effects are less harmful than those caused by NSAIDs or untreated debilitating pain Although Opioids can be habit forming, they can be safely stopped with gradual dose reductions.
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 doctor or health care provider. There may be other medicines or treatments that might work better for you.
Q. My health care provider suggests that I take antidepressants for my pain. Does this mean the pain is just in my head?
A. No! Research has shown that some antidepressant medicines can help relieve some types of pain. Other medicines known to help certain kinds of pain include anticonvulsant drugs, such as Neurontin (gabapentin) and Lyrica (pregabalin). Topical local anesthetics (skincreams), such as lidocaine, are available in a patch to be applied over the painful area. 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.
Q. What can I do besides taking medicines?
A. There are many things you can do. The more you know about your pain, the more you can do to control it. There are 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 helpful. Ask about physical therapy, exercise, or fitness programs that can help 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, massage, acupuncture, and transcutaneous electrical nerve stimulation (TENS), may help some people. Other mental and physical treatments such as relaxation, music and distraction may help as well. It is important to ask your health care provider about the usefulness of these and other treatments for your specific problem.
Q. What if my pain is not relieved?
A. 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 of all pain, much can be done to control or manage most persistent or chronic 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
- 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 Foundation
201 North Charles Street, Suite 710
Baltimore, MD 21201
888-615-PAIN (7246)
www.painfoundation.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
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