Pain Management (Knee Pain, Back Pain, Stomach Pain)
Caring for Elders: Tips for Managing Pain
Older adults are more likely to experience pain than the general population but they may be less likely to be treated for it. The most common reason that pain in elders is under treated is that it is under reported. Many elders consider pain a natural consequence of aging – something they just have to live with – and don’t report it to their doctors. Untreated chronic pain puts a great deal of stress on the body and on the individual’s emotional health as well. It can lead to depression, anxiety, reduced mobility and strength, and loss of appetite and sleep.
Chronic pain in elders can be caused by a wide range of factors. It is most frequently associated with musculoskeletal disorders such as arthritis and degenerative spine disorders but may also be linked to conditions such as cancer, shingles, circulatory problems, and fibromyalgia, or may result from damage to nerves or the central nervous system. The first step for an elder suffering persistent pain is to have a doctor determine the source of the pain. It is important to see a doctor who is familiar with pain assessment and treatment in elders, since the approach to pain management is different in older people than in the general population.
For less intense pain, I first recommend non-pharmacological steps like ice packs, physical therapy, and exercise. When pain relievers are called for, I recommend the progressive guidelines recommended by the American Geriatric Society. Pain can be effectively managed in elders and pain relievers are safe for these patients, but they must be prescribed cautiously, since older people metabolize medication differently, are more prone to side effects, and may suffer complications from interaction with other medications. For these reasons, doctors often start their older patients on the lowest possible dose of a pain reliever and increase the dosage only as necessary.
The American Geriatric Society classifies pain relievers in four groups: non-opioids, including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs); opioid analgesics; adjuvant drugs; and other medications.
- Non-opioids: Acetaminophen (Tylenol) is generally the first choice for pain relief in elders, particularly for arthritis and lower back pain. While there is some risk of liver damage with long-term use at high dosages, acetaminophen is the safest pain relief option. NSAIDs (aspirin, ibuprofen, naproxen) may be more effective for inflammatory pain but pose serious risks of gastrointestinal bleeding and cardiovascular complications. Dr. Landsverk recommends avoiding them.