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Ever had one of those days when it feels like every single inch of your body hurts? For many of us, that’s just a bad day. But for some, living with aches and pains becomes their everyday reality. This is especially true as we get older. According to an article in the journal CureUs, a majority of elderly individuals suffer from pain that has become chronic and interferes with their day-to-day lives.
Chronic pain can be tough to define. The Cleveland Clinic says chronic pain is “ongoing and usually lasts longer than six months.” Johns Hopkins Medicine defines chronic pain as “long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis.” And according to the UK’s National Health Service, chronic pain is “pain that carries on for longer than 12 weeks despite medication or treatment.”
Though these definitions are slightly different, the theme is the same: chronic pain lasts for a long while and it can be difficult to provide medication or treatment that makes it go away.
Acute pain is the opposite of chronic pain in that it lasts for only a short period of time. For instance, let’s assume you break your leg. You’ll definitely need pain medication right after that injury! But within a matter of weeks or even days, you might not need as much pain medication. And soon, you won’t need it at all. Acute pain can be treated effectively and goes away within a reasonable period of time.
Either way, living in pain is never a good thing. But sometimes pain medications can bring side effects that are quite troublesome. A good doctor looks for the fine line between medicating the pain properly and avoiding side effects that can make life tougher. Here’s what you need to know about treating everything from a simple headache to medications for serious chronic pain.
The Dangers of Pain in Seniors
When you’re in pain, it’s safe to say you aren’t at your best. But there are clear studies that show just how serious pain can be for seniors. Chronic pain is associated with a higher chance of depression, sleep disturbances, and falls[1]. That’s one reason it’s so important to have medical alert technology with you at all times, especially if you are suffering from chronic pain.
In addition, pain medications themselves can pose a danger to seniors, not only for the possibility of interactions with other drugs, but for the side effects. Some of those side effects can include drowsiness, fatigue, dizziness, and the like – all of which can lead to falls. You should always have your panic button alarm at the ready, but especially when you’re on medications.
Potential Pain Medications for Seniors
The American Geriatrics Society issues the guidance for medical professionals concerning pain relief in elderly adults. The recommendations include starting out with the mildest drug and going up from there depending upon how well it works[2]. There’s a good reason they start with low doses. According to WebMD, the aging body introduces many issues with medications, such as kidneys that don’t filter as well as they used to, a liver that has difficulty breaking down medications, and decreased saliva that can lead to trouble with swallowing. Even changes in stomach acid levels can contribute to how well (or not) a drug is absorbed.
When you’re being treated for pain, the medication you are given will be determined not only by these guidelines, but by the injury or illness that is causing the pain, the severity of it, and other factors that might be at play, such as your pain tolerance or other medications you are on. The following are some of the more common medications you might use for pain, starting with the over-the-counter options.
· Acetaminophen. Sold under the brand name Tylenol, this drug is considered a first-line agent for mild to moderate pain by the American Geriatrics Society. It works particularly well for low back pain and osteoarthritis, as well as the common headache and smaller aches and pains.
· NSAIDs. These non-steroidal anti-inflammatory drugs include drugs like ibuprofen (Advil or Motrin) and naproxen (Aleve), as well as a few others. These work well when acetaminophen is not enough. They are great for treating inflammatory pain; however, they should only be taken for short periods of time, as they can lead to serious gastrointestinal, renal, or cardiovascular problems. In fact, studies have shown that NSAID-related side effects were a cause of hospitalization for 23.5% of elderly patients[3].
· Topical Medications. Mostly available by prescription, these are in the form of a cream that can ease pain at the site of application. They include topical NSAIDs, capsaicin, lidocaine, and more. These lead to many fewer side effects than oral NSAIDs, though some do result in skin irritation, particularly if you have a condition like psoriasis or eczema[4].
· Opioids. These medications are reserved for severe pain or for pain that doesn’t resolve with other treatments. In the short term, these medications work very well. However, in the long term, they often result in difficult side effects and are highly addictive, which comes with its own set of problems. These include names such as fentanyl, morphine, tramadol, and oxycodone.
· Anticonvulsants. Medications like gabapentin work well for diabetic neuropathy and other nerve pain. They are usually prescribed for two to four months and can lead to a 50% reduction in pain when used daily[5]. SNRIs, or serotonin-norepinephrine reuptake inhibitors can also help with neuropathic pain.
· Benzodiazepines. This is a strong medication that is often used as a sedative to treat anxiety, but they can also treat pain. However, the adverse effects can include cognitive decline and a higher risk of falls; in fact, up to 20% of falls in the elderly are caused by the use of these drugs[6]. Therefore, your doctor will only prescribe these if you really need them and other drugs don’t work well for you.
· Cannabinoids. Now legal and available by prescription, the use of cannabis among those age 65 and older has shown to reduce pain by a substantial amount. It also offers more safety than opioids do[7]. Side effects can include a wide variety of issues, including dizziness and sedation, both of which warrant the use of a medical alert pendant to get help immediately if you fall down when using these medications.
Staying Safe with Over the Counter Medications
Many pain medications can be purchased over the counter. You likely have some in your medicine cabinet right now. The most common of these include acetaminophen or ibuprofen. The safest option in OTC medications for seniors is acetaminophen, which is safe for daily use provided that you never exceed 3,000 mg per day. That’s because high doses can lead to serious liver problems. If you have liver disease or a history of alcohol abuse, even 3,000 mg each day will be too much.
It’s important to remember that acetaminophen is often added to other medications, such as Nyquil or Theraflu. So when you take these medications in addition to more acetaminophen, you might easily exceed the daily limit, which can lead to an accidental overdose.
Seniors should use ibuprofen very carefully. There are several risks with taking NSAIDs in high doses or on a regular basis, such as decreased kidney function, problems with your stomach lining, or internal bleeding in your abdomen. It can also interfere with blood pressure medications, lead to fluid retention and increase your odds of heart failure[8]. Unfortunately, NSAIDs cause about 41,000 hospitalizations and 3,300 deaths each year for elderly adults[9].
What About Aspirin?
You might have noticed that the old workhorse for pain – aspirin – is not on the list. That’s because the medical community no longer considers aspirin a good option, as it can greatly increase the risk of internal bleeding[10]. Though you might be prescribed a “baby aspirin” per day to protect your heart, it’s not something you should reach for to treat pain.
Put Senior Safety First When Choosing Medications
Just like the doctors put your safety first when choosing what to prescribe, you should do the same when choosing which over the counter drugs to use. Taking care of yourself includes following the doctor’s recommendations for pain medication, taking good care of senior whole health by exercising and eating right, keeping your home free of clutter and safe with aging in place solutions, and getting a medical alert watch or pendant to get help to you immediately if an emergency arises. This is especially important if you are on pain medication that can affect your balance, make you feel lightheaded or dizzy, or leave you fatigued. As your fall risk goes up, it’s important to have a button alarm right there at your fingertips, just in case. After all, you don’t want to suffer a fall that results in injury and wind up taking even more pain medication!
Alert1 wishes you health and safety!