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Patient Education Forum Persistent Pain By the AGS Expert Panel, The Management of Persistent Pain in Older Persons

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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."

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.

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.

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.

• 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.

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.

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.

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.

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.

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.

• 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