When you’re younger, it may be easier to shrug off pain or work through it. The old expression, No pain, no gain is the mantra of many athletes. But as we get older, pain has a way of getting us down faster and keeping us there longer. We don’t bounce back like we used to. This is especially true when pain is present.
What can be done about it? Medications are one possibility but knowing what to take and when to take it can be another difficult hurdle to jump. That’s why the American Geriatrics Society has published Guidelines for Pharmacologic Therapy. The specific focus is on medications for chronic pain in older adults. Chronic (or persistent) pain is defined as pain that lasts more than three months. Older adult refers to men and women 65 years old and older.
What medications are available and who should take them? Pain medications including acetaminophen (Tylenol), nonsteroidal antiinflammatories (NSAIDs), opioids (narcotics), adjuvant (additional other) analgesics, topical analgesics (rub on creams and gels), and other drugs are available. Here’s a brief summary of each class of drugs.
Acetaminophen (Tylenol): Safe and effective, the first choice of drug for pain relief. Patients should not take more than a total of 4 grams each day. Anyone with liver disease or who abuses alcohol cannot take this drug.
Nonsteroidal antiinflammatories (NSAIDs): More effective than acetaminophen for chronic inflammatory pain but with possible gastrointestinal problems. Should not be used by anyone with an active stomach ulcer, kidney disease, or heart failure. Patients on NSAIDs must be monitored carefully for any signs of adverse effects.
Opioids (narcotics such as Lortab, OxyContin, Percocet or Percodan, Morphine): Anyone who has not responded to acetaminophen or NSAIDs and who has moderate to severe pain that affects daily function should be considered for opioid pain relievers. Newer and better drugs of this type are available that are safe and effective. Opioids should only be prescribed and monitored by knowledgeable physicians with experience using these drugs.
Adjuvant analgesics: refers to drugs developed for some other purpose than pain relief but useful for persistent pain. Includes some anticonvulsants, antiarrhythmics, and antidepressants. Used most often for people with fibromyalgia, nerve pain, chronic and severe back or bone pain, and headaches. Often prescribed along with other pain relievers.
Topical analgesics including lidocaine, NSAIDs, and capsaicin: Available as a patch or topical gel, these medications are useful in controlling nerve pain. Patients with diabetic neuropathies or chronic musculoskeletal problems seem to benefit the most. Patients must avoid use around open wounds or mucous membranes and stop use if a skin rash develops. Patients should be warned to expect a burning sensation.
Other drugs: Efforts are ongoing to find other drugs that might be useful in controlling or managing various types of chronic pain. For example, muscle relaxants, oral (systemic) corticosteroids, calcitonin, and bisphosphonates have been used as a second-line treatment approach after some of these other, less risky medications. When it comes to pain control, much more research is needed to understand what works and why.Don’t try to figure this out on your own. See your physician for an examination and evaluation of your problem. Find out what you really need. There’s no sense in suffering but you also want to take the right medication (and take it correctly) to get the best results.