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You Don't Have to Live With Persistent Pain


Although many people experience more pain with age, it is not a normal part of life. Here are some tips for identifying your pain and working with your doctor to manage it.

The American Geriatrics Society (AGS) has guidelines on explaining and managing persistent pain. This term refers to pain or discomfort that continues for an extended period of time. Pain may come and go for months or years. Persistent pain can lead to further problems including depression, social isolation, disability, difficulty walking, falls, sleep problems, and diminished appetite. However, there are ways you can reduce this pain.

Identifying Your Pain

The first step is to keep track of your pain and tell your doctor about it. To give a clear explanation of what you are feeling, write down details about the pain, such as:

  • Where it hurts
  • How often it hurts
  • How much it hurts
  • What the pain feels like, for example:
    • Burning pain
    • Sharp or dull pain
    • Achy pain
    • Pins and needles
    • "Shooting" through the body
  • What makes the pain go away
  • What causes the pain to worsen
  • What medicines or treatments have been tried, how well they have worked, and what side effects (if any) they may have caused
You should also be prepared to tell your doctor about how the pain effects your daily life.

Keep a pain diary. This involves using a scale of 1-10 to rate the severity of pain, as well as recording the pertinent information listed above. You should bring this diary to all your medical appointments. This information will help determine the best way to manage your pain.

Understanding Pain Medications

Many medicines are available to help treat pain, these include over-the-counter pain relievers and prescription pain medicines.

Over-the-counter Pain Relievers

If you have mild to moderate pain that lasts for only a few days, over-the-counter products are both safe and helpful for most people. However, if your pain is severe or lasts longer than a few days, you might need a prescription drug for relief.

There are two main categories of over-the-counter pain relievers:

  1. Acetaminophen (eg, Acephen, Genapap, Tylenol)—This drug can be very helpful for mild to moderate pain caused by musculoskeletal conditions, such as osteoarthritis or low back pain. If you need to take acetaminophen for more than a few days at a time, tell your doctor. Also, never take more than the recommended dose, as there is a risk of serious liver damage with overuse of acetaminophen.
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs)—NSAIDs may be more effective for inflammatory pain, such as that associated with rheumatoid arthritis. While generally available without a prescription, these drugs should be taken only after discussion with your doctor. They tend to have more side effects in older people and may also affect medical conditions (like cardiovascular disease) and interact with prescription drugs. Tell your doctor about your use of these drugs and all other medicines, both prescription and over-the-counter. Examples of over-the-counter NSAIDs include:
    • Aspirin
    • Ibuprofen (eg, Advil, Motrin-IB, Nuprin)
    • Naproxen (eg, Aleve, Naprosyn, and others)
    • COX-2 inhibitors

Prescription Pain Medications

Depending on your pain, your doctor may prescribe pain medicine. Some common drugs are:

COX-2 Inhibitors

The action of these drugs is similar to that of over-the-counter NSAIDs, but is more selective. They are often more expensive than other NSAIDs but may have lower stomach side effects than other NSAIDs.

Opioid Medications

Opioids may be preferred for older patients who are at greater risk of problems that can be caused by NSAIDs. These are drugs that work on the central nervous system to relieve pain. Examples of mild opioids include hydrocodone (eg, Vicodin) and codeine. Strong opioids include morphine, oxycodone, hydromorphone, and fentanyl. There is some concern that opioids are addicting. However, the AGS points out that addiction to opioid pain medicines is rare in older adults who have no current or past history of substance abuse, and this concern should not prevent people and their doctors from trying this option for pain relief. If your doctor is considering prescribing opioids to treat your chronic pain, he will use screening tests and questionnaires to determine if you are at risk for addiction.

It is important to know that if you are taking an opioid drug, you should not stop it abruptly. This can cause unpleasant symptoms.

Other Medications

Depending on the cause of your pain, your doctor may prescribe one of these other types of drugs alone or with pain medicines to help ease your discomfort:

  • Antidepressants (eg, Desipramine and Duloxetine)
  • Anticonvulsants (eg, Tegretol and Neurontin)
  • Local anesthetics (eg, lidocaine)

Side Effects

Be alert for side effects and tell your doctor about them; there may be better options for you. Some possible side effects include:

  • From NSAIDs or COX-2 inhibitors:
    • Kidney problems (more common in older adults)
    • Problems with high blood pressure
    • Stomach bleeding
    • Increased risk of heart attack and stroke
  • From opioid medicines:
    • Dizziness
    • Sedation
    • Nausea and vomiting
    • Short term memory problems
    • Constipation—For the other side effects, the body usually adapts quickly. But for constipation, you may need to take a stool softener or laxative on a daily basis.
    • Sexual dysfunction

Trying Other Means to Ease Your Pain

Drugs are not the only way to ease pain. Here are some options that can be helpful in conjunction with the treatment your doctor prescribes:

  • Exercise, including physical therapy and fitness programs—Exercises like yoga and Tai Chi can help you stay flexible, improve your balance, and reduce your risk of falls.
  • Eat a healthy diet, rich in fruits, veggies, and whole grains—A healthy diet will give you the energy you need to stay active.
  • Maintain an active lifestyle, including keeping up social engagements—This can help you avoid isolation and depression.
  • Stay involved in your care—Tell your doctor how your medicines are working and if you are having any side effects.

Other therapies that might help with pain include:

  • Use of heat therapy
  • Acupuncture
  • Massage
  • Relaxation therapy

Even if these methods do not resolve all of your pain, you may be able to reduce your pain to a more manageable level. The most important thing is to know that you do not have to suffer. Work with your doctor to find some relief.

RESOURCES:

American Chronic Pain Association
http://www.theacpa.org/

The American Geriatrics Society Foundation for Health in Aging
http://www.healthinaging.org/

American Pain Society
http://www.ampainsoc.org/

CANADIAN RESOURCES:

Chronic Pain Association of Canada
http://www.chronicpaincanada.com/

Health Canada
http://www.hc-sc.gc.ca/

References:

Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003;349:1943.

Cancer pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated July 2, 2012. Accessed August 1, 2012.

Celecoxib. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 15, 2012. Accessed July 17, 2012.

Chronic low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 29, 2012. Accessed August 1, 2012.

Falls in the elderly. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated July 16, 2012. Accessed July 30, 2012.

Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174(11):1589.

Opioids for chronic pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated July 13, 2012. Accessed July 30, 2012.

Pain management. Health in Aging website. Available at: http://www.healthinaging.org/aging-and-health-a-to-z/topic:pain-management/. Updated March 2012. Accessed July 30, 2012.

Pharmacological management of persistent pain in older persons. American Geriatrics Society website. Available at: http://www.americangeriatrics.org/files/documents/2009_Guideline.pdf. Published 2009. Accessed July 30, 2012.

12/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Leveille SG, Jones RN, Kiely DK, et al. Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA. 2009;302(20):2214-21.

11/5/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Buckeridge D, Huang A, Hanley J, etc. Risk of injury associated with opioid use in older adults. J Am Geriatr Soc. 2010;58(9):1664-1670.



Last reviewed July 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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