Safe Pain Management for Seniors

With age comes a few inevitable aches and pains but seniors and caregivers of elderly adults may want to pay closer attention to what they use for pain relief.   Chronic pain is one of the chief complaints among elderly people living in nursing homes and if left untreated can result in poor sleep, limited mobility and can lead to social isolation, depression and anxiety.

Monitoring what drugs older adults are given for pain and how often is very important in preventing serious side effects due to dangerous interactions with other medication as well an increased risks for ulcers, gastrointestinal bleeding, increased high blood pressure and a greater chance of heart attack and stroke.

Drugs commonly used for pain over long periods of time like ibuprofen, naproxen and high dose aspirin can be dangerous for elderly people.  The United States Food and Drug Administration strengthened its warning for the use of non-steroidal anti-inflammatory drugs in 2015, stating that NSAIDs can increase the risk of heart attack and stroke.  It is important not to take more than one NSAID product at a time and always check with a doctor or pharmacist to rule out any drug interactions.  The revised recommendations do not apply to aspirin.

The American Geriatric Society takes it one step further warning that NSAIDs should only be taken by older adults with extreme caution.   The AGS strongly recommends that NSAIDs and COX-2 painkillers should not be used by seniors except in rare circumstances.  These include Motrin, generic ibuprofen, naproxen (Aleve) and prescription strengths including celecoxib (Celebrex) and indomethacin (Indocin).

Besides the cardiovascular risk for seniors, these drugs can interfere with kidney function and irritate the lining of the stomach and bowels resulting in internal bleeding.  Acetaminophen (Tylenol) is commonly used to manage pain in older adults but is not a good choice for heavy users of alcohol.   When acetaminophen is not effective or cannot be used safely, doctors are now advised to prescribe opioid pain relievers after screening first for addiction issues.

In addition to avoiding NSAIDs, older adults should also stay away from PM versions of any pain medication because they contain antihistamines, known as anticholinergics which can cause confusion, dry mouth, difficulty urinating and constipation in seniors.  Drugs used for dementia or Alzheimer’s can be interfered with by anticholinergic drugs.

For updates on FDA consumer recommendations visit: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm and for more information about pain management in the elderly population speak with your doctor or pharmacist.