Pain Management

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Care & Treatment

People with pain need to be involved in treatment decisions and educated about their pain. So do their caregivers, if they have any.

Treatment results vary depending on the type and cause of pain. And, people’s responses to pain relief methods vary. So, with a healthcare professional’s advice, a person may have to try several pain relief methods before finding those that work. 

Non-drug Methods

These methods can relieve pain and may reduce the need for medications. These methods include:

  • Cognitive-behavioral therapy such as self-hypnosis and coping strategies
  • Regular physical activity, such tai chi and other forms of gentle exercise
  • Rehabilitative services, like physical therapy to help improve a person’s abilities
  • Diversions such as music, story-telling sessions, television, and pet therapy
  • Applying hot or cold treatments to the skin
  • Relaxation methods, such as meditation, deep breathing exercises, yoga, and massage
  • PRF (Pulsed Radiofrequency) treatment, which sends short radio waves through the skin to target nerve pain
  • Interventional pain management (for example, injection of a temporary local anesthetic or steroids to relieve pain at the site it occurs)

Older adults can have multiple health problems that affect how they respond to medication. For example, your healthcare professional will usually start with a low dose of a pain medicine and slowly increase the dose until you feel less pain.

Among the medications professionals may recommend are:

Acetaminophen (Tylenol)

This is usually the first medication to try for low to mid-level pain, especially if it comes from joint, muscle, or bone pain. Some cautions are:

  • .Acetaminophen is in many cold and flu medicines. So, avoiding overdose is important.
  • Use the drug carefully if you have the following diseases:
    • Liver disease
    • Severe kidney disease
    • A history of alcohol abuse

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDS are drugs like aspirin, ibuprofen, or naproxen. These drugs may cause bleeding in a person’s stomach and intestines. Other harmful side effects can happen with risks to a person’s kidneys or heart, especially in older adults. For example, women over the age of 85 are at high risk of bleeding when they take NSAIDs.

Do not combine ibuprofen and aspirin.

Opioids

Opioids are only available by prescription and can help with moderate to severe pain, including cancer pain. Side effects include:

  • Nausea
  • Constipation (laxatives and stool softeners can help)
  • Sedation, fatigue, sleepiness
  • Memory disturbances, confusion
  • Itching
  • Increased risk of falls
  • Potential for addiction 

Some side effects often go away after a few days.  Stopping long-term use of opioids quickly can lead to withdrawal symptoms. So, the opioid dose should be slowly reduced.

In older adults, the health care professional needs to monitor for interactions with other drugs the person takes, impact on cognition, and any improper use.

Adjuvant Medications

A variety of other products can provide good pain relief for many people. These medication are often used for other purposes (such as treating depression or seizures). They include the following:

  • Lidocaine: applied directly to the skin and available as a cream or patch
  • Capsaicin: made from hot peppers and available as a cream or patch
  • Antidepressants: usually at lower dosages than for treating depression
  • Anticonvulsants : for nerve pain
  • Corticosteroids: Medicine injected directly into joints, tendons, or muscles or taken orally to help inflamed tissues

Person-controlled Pain Relief

People with long-lasting pain can have control over their pain relief. They use a pump or other method to give themselves the medication when they need it. The medicine is administered through a line into the person’s body. People actually use less medication this way.

Cannabis (marijuana)

Cannabis may have an impact on nerve pain, but there is no evidence that it affects other types of pain. Older adults have a higher risk of side effects from cannabis than younger adults because of bodily changes due to aging and the potential for drug interactions.

Caregiver Involvement

If a person has a caregiver, they need to be included in these strategies. Family members may be able to use safe and simple methods to increase comfort and reduce distress. For example, touch and massage can help.

Older adults with serious illness who are confined to bed need, regular repositioning, passive range-of-motion exercises, and gentle massage.

Regular Treatment

Regular follow-up visits with healthcare professionals is necessary to keep track of how well the pain treatment is working. Also, the healthcare provider needs to track side effects and change medication doses as needed. Periodic laboratory tests may be necessary.

Contact your healthcare provider if your pain is still there or if you have side effects. 

 

Last Updated December 2022

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