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Pain Management and the Elderly

The older adults are often undertreated or untreated for pain. The elderly pain population presents many challenges for pain practitioners, including declining mental and physical function, polypharmacy, and other medical conditions. Safe pain treatment is available for the elderly.  The pain many older adults experience is just a natural part of aging and don’t tell their physicians about their problem. While they are more likely to experience pain than the general population, in most cases, they are undertreated. The consequences of under-treatment can have an adverse impact on the health and quality of life of the elderly. It can result in sleep disturbances, immobility, cognitive impairment, social isolation, anxiety, and depression. If you or someone you love is in pain, talk to a doctor.

Pain Management- Medication use in the elderly

While there are a number of pain relievers that are safe for use for the elderly, physicians must take precautionary measures when prescribing pain medication. As compared to younger patients, older patients handle pain medication differently. This is because, as our kidneys become smaller with age, the blood flow ultimately decreases and hence, the filtration process (removal of drug) becomes less effective. Additionally, the liver suffers a decrease in blood flow and mass with aging, making it harder for the liver to break down medications.

On the other hand, the medications administered to the elderly can also become a challenge. For example, injections may be more problematic in the decreased muscle mass and decreased saliva may impede with swallowing.

To overcome these challenges, physicians often start their elderly patients on the lowest recommended dosage and then increase the amount gradually if it seems necessary.

Assessment of Pain in the Elderly

Effective pain assessment in the older adults can be challenging. It necessitates an acknowledgment that such discomfort may present abnormally, especially in the cognitively impaired. As biological markers are not obtainable, self-reporting is considered as the best evidence for the incidence of pain and an ideal way to access its intensity. Doctors should frequently ask about the presence of pain in older adults. Using screening tools and simple questions, pain can be easily accessed, even in the elderly with dementia.

A comprehensive pain assessment should include a careful physical examination, diagnostic studies, and medical history aimed at determining the precise etiology of the pain. Factors such as location, frequency, and intensity should be described.

Treating Pain in the Elderly- Medication Risks and Contradictions

#1 NSAIDs

NSAIDs or Nonsteroidal Anti-Inflammatory Drugs are commonly used to treat musculoskeletal pain in older adults. Obusforme products like body pillow and other lumbar support products can help those taking NSAIDs for long-term pain relief therapy.  The use of NSAID is frequent among the elderly, but these drugs pose considerable threats to the elderly population. That is, NSAIDs may be beneficial in some elders without renal or heart issues but they may interfere with certain necessary medications for renal problems, heart problems, or possibly contradict with certain medications.

Older adults are at an increased risk of gastrointestinal toxicity associated with Nonsteroidal drugs, particularly peptic ulcers. Moreover, they are the common malefactor in hospitalization due to drug-to-drug interactions, as they tend to negatively interact with commonly prescribed medications like antihypertensives, selective serotonin receptor inhibitors (SSRIs), and aspirin.

#2 Adjuvant Analgesics

Adjuvant Analgesics are another common type of medication used in older adults. These medications primarily focus on treating the side effects that occur during pain management, particularly in the management of neuropathic pain.

#3 Opioids

The 3-Step Ladder for Pain Management in the Elderly recommended by the World Health Organization suggests the use of opioids after the use of Nonsteroidal drugs and Adjuvant Analgesics were unsuccessful in providing pain relief. Opioids such as methadone, fentanyl, oxycodone, and morphine, are commonly prescribed drugs for treating both acute and chronic pain in the elderly.

However, the doctors must consider the dosage when prescribing opioids to the elderly these drugs are addictive in nature and are amongst the most used and abused substances across the globe.

Therefore, the physicians must discuss the risk versus advantages associated with opioid-based treatment prior to prescribing. The risk factors or you can say the side effects the older adults may experience while on opioids include sleep disturbances, increased falls, respiratory depression, gastrointestinal complications, nausea, and constipation.

What makes it riskier is that these side effects are treated pharmacologically that further increases the number of drugs the elderly ingest each day.

The older adults should be instructed to avoid consuming alcohol when on opioids medications, besides avoiding sedatives like benzodiazepines as they can increase the risk of respiratory depression.

Final Words

Remember, medications including opioids have been linked to morbid body composition changes comprising a decrease in bone, fat, and muscle mass, possibly leading to an increased risk of overdose.

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Updated: November 29, 2018 — 7:18 am

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