Decision Focus: Seniors and Pain Meds
Seniors and pain are a common mix. Find out about your pain medication options, the side effects of NSAIDs and the truth about opioid drugs lik...

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image of thoughtful older woman Decision Focus: Seniors and Pain Meds

If you are like a lot of seniors, then pain from severe arthritis, or another condition may be a daily reality. But you don't have to accept pain as part of getting older. If you are not taking medication or if your current regimen of medicines is not quelling the pain, then it's time to speak up.

Your doctor may be able to suggest physical therapy, massage or other treatments together with pain medication. Maybe it's time to see your doctor and rethink your pain management strategy.

What are my non-prescription pain medication options?
For many, acetaminophen (like Tylenol) and NSAIDs are two common over-the-counter options for minor pain.

  • Acetaminophen. Acetaminophen (such as Tylenol) is a good drug for relatively minor aches and pain. It is the first choice of pain medication according to American Geriatrics Society guidelines. But don't take it if you have liver failure, kidney problems or drink a lot of alcohol. Also be sure not to take more than the maximum daily recommended dosage, and do not take it with other medicines that also contain acetaminophen.
  • NSAIDs. NSAID stands for nonsteroidal anti-inflammatory drugs. These include ibuprofen (Advil, Motrin) and naproxen (Aleve). Recent guidelines advise most seniors (aged 75 years and older) to avoid taking these medications regularly. The risks include ulcers and bleeding, and they may outweigh the benefits for many seniors. If you have been taking these medications, talk to your doctor. Your doctor can help decide whether taking NSAIDs is OK for you.

Do not take ibuprofen (Motrin, Advil) with aspirin (even low dose). Also, don't take aspirin or NSAIDs if you take other blood thinning medications unless instructed by your doctor.

What can the doctor prescribe for more severe pain?
Opioids (also called narcotics).
If acetaminophen (such as Tylenol) isn't working, and NSAIDs would not be safe to use, your doctor may prescribe a stronger pain medication called an opioid. Opioid drugs are related to morphine, which is used in severe pain. But, there are weaker forms of opioids that can be used for different kinds of pain. Some common opioids include hydrocodone, codeine and oxycodone.

  • Pros of opioids: Opioids work very well against moderate or severe pain. They are considered safer than the NSAIDs for some seniors, especially for those with ulcers, kidney problems, high blood pressure or heart failure.
  • Cons of opioids: You must be very careful to follow your doctor's instructions. Too high a dose can stop breathing and be fatal. These medicines can also make you drowsy and increase your chance of falling. Also, do not drink any alcohol if you are taking these medicines. Make sure your doctor is aware of all the other medicines that you are taking. Constipation is a common side effect. This can often be managed with certain laxatives, exercise or dietary changes.

Antiepileptic drugs. Some medications used to treat epilepsy are also effective for nerve pain (neuropathic pain). You may be prescribed an antiepileptic for diabetic neuropathy, or the pain that follows shingles. These are painful conditions caused by peripheral nerve damage. One of the medicines from this class that may be used for pain is gabapentin (Neurontin).

  • Pros of gabapentin: It can help some types of nerve pain.
  • Cons of gabapentin: You may need blood tests to check liver and kidney function while on these medicines. You may need multiple doses in one day.

SSRIs or other antidepressants. Your doctor may prescribe certain types of antidepressants, such as an SSRI, for certain types of pain.

  • Pros of SSRIs: May be a good option for nerve pain or fibromyalgia.
  • Cons of SSRIs: These drugs may cause nausea or diarrhea but these effects may subside as your body adjusts to the medicine.

Muscle relaxants. These medications may be added to another pain medication for back pain with muscle spasm. The main drawback of muscle relaxants is that they can be very sedating. You should take the lowest possible dose.

Corticosteroids. Corticosteroids, such as prednisone, are not the same type of steroids abused by athletes. Your doctor may prescribe a corticosteroid for inflammation or painful bone cancer. For some types of arthritis confined to one joint, your doctor may inject a corticosteroid to reduce pain and inflammation.

  • Pros of corticosteroids: They are very good at relieving pain caused by inflammation
  • Cons of corticosteroids: Taken long-term, corticosteroids can lead to osteoporosis and other serious problems. They can also suppress the immune system.

Topical pain medicines. Salicylates and some anesthetics (numbing drugs used during surgery) can be delivered in small doses to the skin as an ointment or patch.

  • Pros of topicals: These drugs usually cause fewer side effects because you are not taking them by mouth.
  • Cons of topicals: They are only effective over a small area.

What is important to me?
Deciding on a drug or drug combination for pain can be a challenge for you and your doctor. You may hold deeply seated personal beliefs about taking pain medication. You may feel ashamed or embarrassed to ask for help. Many people feel this way.

But it's important to look at whether pain is getting in the way of your daily life. If it is, talk to your doctor about your pain and how you feel about taking pain medication. Sometimes, pain can be managed with a combination of therapies, such as physical therapy and medication. You may be able to find answers that put you back in control.

By Louis Neipris, MD, Staff Writer
Created on 08/05/2009
Updated on 08/11/2009
Sources:
  • National Pain Foundation. Seniors and Pain
  • American Geriatrics Society. Pharmacological management of persistent pain in older persons, 2009 guideline recommendations.
  • Kuehn BM. New pain guideline for older patients. Avoid NSAIDs, consider opioids. Journal of the American Medical Association. 2009;302(1):19
  • Deane G, Smith HS. Overview of pain management in older persons. Clinics in Geriatric Medicine. 2008;24(2):185-201.
  • Strassels SA, McNicol E, Suleman R. Pharmacotherapy of pain in older adults. Clinics in Geriatric Medicine. 2008;24(2):275-298.
Copyright © OptumHealth.
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