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 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.   

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 medicine 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 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 medicines (such as diclofenac). They may cause bleeding in the stomach and intestines, and they may have other serious side effects (such as a risk for causing kidney damage or problems with your heart health) that can limit their usefulness in many older patients. Women over the age of 85 are at particularly high risk of bleeding when they take NSAIDs. The U.S. Food and Drug Administration (FDA) especially cautions against combining ibuprofen and aspirin.

Opioids

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:

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

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. 

Adjuvant Medications

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 the dose used for treating depression
  • Anticonvulsants: These medicines may be effective for some people with nerve pain
  • Corticosteroids: Medicine injected directly into joints, tendons, or muscles or taken orally to help soothe 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 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 in this way.

Nonpharmacologic Approaches

A number of non-drug strategies, used alone or in combination with prescription 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, and pet 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

Caregiver Involvement

When possible, caregivers should be included in these 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.

Monitoring

Your healthcare provider should schedule regular follow-up visits to keep track of the effectiveness of your treatment approach and to consider 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