Pain Management for Senior Citizens

Elderly PainA recent article in the latest edition of the Journal of the American Medical Association discusses the problems with opioids and the elderly. The article discusses the fact that there has been a large increase in hospitalizations tied to the usage of these medications. The problems are multifaceted, as overuse, over reliance and lack of understanding all lead to health problems in the elderly.

Chronic pain is a major health issue, especially as we grow older. Recent studies have shown that about a third of the population suffers from some sort of medical problem that causes chronic pain. Unfortunately, the science of treating pain has not kept up with the recognition of it as a problem. Furthermore, we have recognized the risks of acetaminophen with liver toxicity and the dangers of anti-inflammatories like ibuprofen with the kidneys. With the dangers of those drugs, opioid use has been pushed.

The practice guidelines for the management of pain from the American Geriatric Society has actually promoted the use of opioids for moderate to severe pain. They have discouraged the use of stand-by drugs like acetaminophen and anti-inflammatories. Unfortunately, in the elderly, opioids are very difficult to use safely, especially if one is not an experienced clinician. Senior citizens tend to be much more sensitive to medications, and “regular” doses can cause falls, liver toxicity, cardiac toxicity and cognitive impairment. Furthermore, half of the authors of the guidelines had significant financial ties to manufactures of opioids.

Careful Management

Chronic pain in the elderly, as it is in any other group of patients, is not one size fits all solution. Pain is a complex entity and needs to be treated as such. The multiple causes of the pain need to be diagnosed and each contributing factor should be treated with the most appropriate management option. Joint related pain may be best treated with an anti-inflammatory medication while neuropathic pain may need a seizure type drug. Furthermore, depression may be a factor and that may also need separate treatment since pain and depression centers in the brain are closely situated.

Management of pain is complex. Careful determination of all the causes and selective treatment by a skilled and knowledgeable practitioner is beneficial. More research on pain and treatment is necessary since the problem is so large. Pain specialists are often the experts needed to find the best management options.