Caregiver Guide: Pain

Understanding the Problem

Some people think that pain is natural with aging. Others may believe that older people are “just complaining” if they are not clear in explaining the cause or nature of their pain. Both of these views are wrong. Having pain is very common in older adults, but it is never normal. There is almost always a real problem behind pain.

Arthritis is said to be the most common cause of pain in people over the age of 65. Nerve damage, shingles, problems with circulation, certain bowel diseases, and cancer are other common reasons for pain in older people.

Muscle pain is also quite common.  A condition called fibromyalgia can cause muscle pain, especially in older women. Another condition called myofascial pain may result from trauma, nerve damage, and arthritis. These conditions are treated differently than other types of pain, and may be best treated with physical therapy without taking any medicine at all.

Pain can lead to other problems such as losing the ability to move around and do everyday activities. The sufferer may have trouble sleeping, experience "bad moods," or develop a poor self-image. In addition, people with pain often become anxious or depressed. They may be at greater risk for falls, weight loss, poor concentration, and difficulties with relationships.

On the positive side, most pain will improve with treatment that uses both medicine and non-medicine strategies. Treatments such as physical therapy, massage, heat and/or cold packs, exercise, and relaxation therapy may be tried first. If these treatments do not provide enough pain relief, pain pills, creams or patches may be prescribed as well.  Since all medicines have side effects, the person should be closely observed for side effects.

Non-Medication Strategies for Pain Relief

There are a number of ways to control pain without medicines.  Often these strategies alone will relieve pain and the use of pain medicine may not be needed. If the healthcare provider prescribes a medicine for the older person’s pain, you should ask if other treatments are also available.

  • Relaxation
  • Physical therapy, such as exercise, muscle stretching and strengthening, as well as heat, cold, and massage
  • TENS (transcutaneous electrical nerve stimulation)
  • Biofeedback
  • Hypnosis

Medicines for Pain Relief

The medicines used to relieve pain are called analgesics. There are many types of analgesics. All of these medicines are worth discussing with a healthcare provider.


Acetaminophen is recommended as the safest type of pain reliever for long-term use which can be purchased at the store without a prescription. It is important to take no more than 2600mg of acetaminophen in 24 hours to avoid possible liver damage and other side effects.  Since many cold medicines and prescription pain pills also have acetaminophen as an ingredient, be sure to check the labels if you are giving an older person acetaminophen regularly.


Aspirin, ibuprofen, and naproxen are examples of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They are also available without a prescription. These medicines are often used to relieve arthritis pain but should not be used for very long because of their unwanted side effects. Older adults are more likely to suffer side effects such as stomach ulcers, kidney problems, and congestive heart failure.  If NSAIDs must be used, older persons should use a medicine such as omeprazole for gastrointestinal protection.

Topical NSAID or anesthetic pain creams and patches that are available by prescription only may be helpful for local pain.  They are most helpful for specific joints or areas and generally do not help pain all over the body. 

Creams and patches

There are creams and patches which are available without a prescription, including capsaicin, methyl salicylate or menthol.  They may also be effective for specific areas of the body. There are other medicines just for nerve pain which work by changing how the brain and nerves perceive pain signals from the body.  These can be taken in addition to usual pain blockers, but may have side effects of confusion, sleepiness or low blood pressure.  As always, the person taking the medicine should be watched closely for side effects.

Believe the person you are caring for. If people with pain think that others do not believe them, they become upset and may stop reporting their pain accurately. This makes controlling the pain more difficult. People with pain are the only ones who know how much pain they are feeling. Pain is whatever a person says it is and exists whenever he or she says it does.

Believe the Person You Are Caring For 

It is important that you, the caregiver, believe the person you are caring for.  If people with pain think that others do not believe them, they become upset and may stop reporting their pain accurately. This makes controlling the pain more difficult. People with pain are the only ones who know how much pain they are feeling.

Pain is whatever a person says it is and it exists whenever they say it does.

Every person has the right to good pain control.

Your job as a caregiver is to make sure that good pain control is provided. Tell the healthcare provider if pain does not lessen with treatment and ask them to try new treatments until the pain is controlled. It is important to also recognize that while most pain can improve with treatment, complete pain relief may not be possible in every case.

Your goals are to:

  • Help evaluate and relieve pain
  • Keep the healthcare provider informed about pain levels and responses to pain treatments

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Last Updated July 2015

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