Pain: it’s just a normal part of aging. Isn’t it? Not necessarily. Pain itself is an indication of an abnormality, and shouldn’t be accepted as an inevitable part of the golden years. Fortunately, there is a growing selection of pain management options for seniors.
What is pain?
At least one in five Americans over the age of 65 report experiencing daily chronic pain. According to the International Association for the Study of Pain, pain is an “unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Pain can be a disruptive force at any age, but it lays an especially heavy burden on seniors. Patients over the age of 65 may already be dealing with underlying physical conditions that limit functionality. Adding the challenge of physical discomfort can dramatically impact the quality of life for older Americans.
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The resigned expectation that pain is an inescapable part of aging is one myth healthcare professionals often have to correct. Patients may also be hesitant to discuss their pain, believing it is better to grin and bear it, rather than to come across as weak or unable to control the pain that they assume their peers are able to manage.
Additionally, patients may believe that everyone with the same condition experiences the same kind of pain. After comparing notes with friends or neighbors, they may worry that Betty, who lives down the street, can manage her pain with long-acting Acetaminophen, while they cannot. They then believe that their pain could signal a worrisome diagnosis. Pain equals the unknown, which equals fear.
The physicality of aging
While not inevitable, as the human body ages, the odds of experiencing chronic pain do increase. Aging leads to a decrease in various neurotransmitters that help reduce pain sensation, such as GABA (gamma-aminobutyric acid), serotonin, noradrenalin, and acetylcholine.
Endogenous analgesic responses also decrease, as do the number of nociceptive neurons. Paradoxically, this can lead to an increase in overall pain sensitivity. Liver and renal function decline, as well as muscle mass, which leads to an increasingly frail body. As a result, a fall they might have walked off in their younger years can cause significant damage and lasting trauma.
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Pain treatment for seniors
Safety is the most important part of a pain treatment plan for seniors. Renal and liver function may be slowed; therefore, drugs take longer to be cleared, resulting in longer half-lives. Any medication should be started at the lowest possible dose until tolerance is understood.
The caveat with seniors is always start low and go slow. Medication can always be added if the desired effect is not achieved, but it cannot be taken away once ingested, particularly for seniors who live alone.
Musculoskeletal and spinal disorders are the most common causes of pain in senior adults. Both conditions can be successfully treated with pharmacological as well as non-pharmacological options. Topical Lidocaine and NSAIDS, as well as physical therapy, can be utilized for musculoskeletal pain. Ice and heat can also be used. Typically, ice is used to decrease swelling and inflammation after exercise, whereas heat is used to warm up a stiffened joint prior to movement
For many years, healthcare professionals have used pain scales to assist in assessing the degree of pain felt by their patients. Pain scales are manufactured in many shapes and designs, but most run from 0 to 10, with 10 signifying the most severe pain.
Elderly patients do not always relate to pain scales, especially if they have a degree of cognitive impairment. Asking them to rate pain as mild, moderate, or severe works well over time, as opposed to defining a 6 or a 7. Asking them how they would describe the pain when they reach for an analgesic is more appropriate, as well as asking how many times a day that severity of pain occurs.
Seniors and opioids
Using opioids or opioid analogs in seniors is generally not the best idea unless the patient has refractory cancer pain, and/or other options have proved to be of little use.
Seniors also present a unique challenge when it comes to pain medication. Older adults may have reserved bottles of old pain medications in their medicine cabinets as a “just in case” measure. They may take these reserve pills in an at-home pain management regimen. The problem with this approach? A patient may mix long-acting opioids with short-acting agents. Add in a bit of renal dysfunction, and the result is a recipe for disaster.
One of the most widely used synthetic narcotics utilized with seniors is Tramadol (Ultram, ConZip). The medication requires a prescription for use, and doses start at 25 mg. All seniors should be started at the lowest dose until tolerance is observed.
This medication is less potent than hydrocodone (Vicodin), as well as other opioids such as fentanyl and morphine, but the potential for addiction and withdrawal still is present. Patients need to be closely monitored while they are on this medication.
Older adults should not have to accept the inevitability of pain in their golden years. Therapists and other healthcare professionals can offer vital guidance to seniors when determining a pain management plan.
- Geriatricpain.org “Common myths about pain – and the reality.” 2020. The University of Iowa.
- Ncbi.nlm.nih.gov “Managing chronic pain in the elderly: an overview of the recent therapeutic advancements.” Ali, A., Arif, A., Ahmad, M. et al. National Institutes of Health, USA. gov.
- Seniorliving.org “Effective pain treatment for seniors.” Hoyt, J., Updated February 6, 2018, Seniorliving.org.
- Uptodate.com “Treatment of persistent pain in older adults.” Galicia-Castillo, M., Weiner, D., Literature review current through July 2020 @ UpToDate, Inc.
- Definition of Pain. IASP-pain.org 1-202-856-7400. International Association for the Study of Pain