In many cases, treating pain with medication can lead to better physical functioning, longer life expectancy, and increased quality of life for older adults.1 But pain medications also pose additional challenges and risks in older adults.

This article will discuss the benefits, challenges, and risks associated with specific classes of pain medication; common reasons adults over age 65 may not take medications as prescribed; and tips for older adults and caregivers managing pain medications.

Article continues below

Medication Options for Pain Management in Older Adults

Medications come with risks and side effects that may disproportionally affect older adults. Commonly prescribed medications to help with pain include:

  • Opioids
  • NSAIDs
  • Acetaminophen
  • Antidepressants
  • Anticonvulsants
  • Muscle relaxants

See Non-opioid and Topical Medications for Chronic Pain

Pain medication can help treat many of the health problems that typically accompany aging. However, medication side effects and potential complications must also be considered.

Opioids

Once they enter the bloodstream, opioid molecules compete with the body's natural endorphins to reach receptors on neurons and block pain signals. Read How Opioids Work in the Brain

New CDC guidelines have made doctors less likely to prescribe opioids, particularly for extended use. They are generally prescribed for short-term post-surgical or acute injury pain, such as when recovering from a hip replacement.

Examples: Common opioids include oxycodone (OxyContin, Percocet, Xtampza), Hydrocodone (Vicodin, Lortab, Hysingla), and Hydromorphone (Dilaudid, Exalgo).

See Types of Opioids

What older adults should know: An enhanced sensitivity to opioids is common in older adults, who may chronic a lower dose than would be recommended for younger adults. Older adults are also more likely to be affected by opioid side effects such as constipation, drowsiness, breathing problems, and nausea.

See Opioids’ Potential Risks and Side Effects

NSAIDs (Non-steroidal Anti-inflammatory Drugs)

NSAIDs are one of the most common pain relievers used for a variety conditions, such as arthritis or other inflammation related pain.

Examples: NSAIDs are available both over-the-counter and prescription. They include aspirin (Bayer, Ecotrin), celecoxib (Celebrex), diclofenac (Voltaren) ibuprofen (Advil, Motrin), meloxicam (Mobic), and naproxen (Aleve, Naprosyn).

What older adults should know: When taken regularly, older adults have a potentially increased risk of causing serious cardiovascular, gastrointestinal, and kidney problems. They also pose an added risk of indigestion, ulcers, and internal bleeding.

Due to the risk of bleeding, NSAIDs should generally not be taken at the same time as blood thinners, which are commonly prescribed to older adults. In some cases, however, the heart attack-preventing aspects of low-dose aspirin outweigh the risks.

Acetaminophen

Acetaminophen is widely recommended for pain, such as headaches or arthritis, and generally safe when used as directed as a nonprescription medication.

Examples: Acetaminophen is available over-the-counter and with a prescription, including Tylenol and Mapap. It is an ingredient in common over-the-counter multi-symptom medications, such as Nyquil, Robitussin, and Sudafed.

The most serious potential risk is for liver damage. This risk is increased if:

  • Doses over 3,000 mg per day are taken for an extended period
  • The individual is already at risk for liver damage (for example, he or she has a family history of liver disease)

What older adults should know: Because acetaminophen is a common ingredient in cold, cough, sleep, and pain medications, it is possible to accidentally take an unsafe dose by taking more than one medication that contains acetaminophen.

Antidepressants

Some classes of antidepressants are used to treat pain, even if depression is not a factor.

Examples: Selective serotonin reuptake inhibitors (SSRIs), such as, fluoxetine (Prozac) and sertraline (Zoloft) are sometimes used to treat pain because they may produce fewer side effects than the others.

What older adults should know: Side effects such as dizziness, drowsiness, and drops in blood pressure may increase the risk of falls and related injuries for older adults.

Dry mouth, confusion, blurred vision, nausea, constipation, and problems urinating also may be experienced.

Anticonvulsants (Antiseizure Medication)

Anticonvulsants may be used to treat painful conditions, such as diabetic peripheral neuropathic pain, fibromyalgia, and restless legs syndrome. They work by calming errant nerve signals in the brain.

Examples: Gabapentin (Neurontin) and pregabalin (Lyrica) are the most widely used anticonvulsants. Both cause drowsiness; however, pregabalin is less sedating than gabapentin.

What older adults should know: Constipation, nausea, and dizziness are common side effects. In some cases, gabapentin increases the risk of suicidal thoughts or actions. It is recommended that major changes in mood be reported to a doctor.

Muscle Relaxants

Most muscle relaxants are used to relax tight, tense muscles and have an overall sedating effect.

Example: Carisoprodol (Soma), cyclobenzaprine (Flexeril), and metaxalone (Skelaxin) are among common muscle relaxants.

What older adults should know: Drowsiness, confusion, nausea, dry mouth, constipation, and urinary problems have been associated with muscle relaxants.

American Geriatrics Society Beers Criteria

Many muscle relaxants, antidepressants, opioids, anticonvulsants, and NSAIDs are listed on the American Geriatrics Society Beers Criteria. Updated every few years, the Beers list identifies medications that may not be appropriate for older people or should be used with extra caution (unless they are prescribed as part of hospice or palliative care). Health care professionals routinely consult the Beers list when choosing appropriate medications for older adults.

Patients who are concerned about taking certain medications are encouraged to talk to their health care providers or pharmacists.

References:

  1. Steinman MA, Hanlon JT. Managing medications in clinically complex elders: “There’s got to be a happy medium.” JAMA : the journal of the American Medical Association. 2010;304(14):1592-1601. doi:10.1001/jama.2010.1482.
Pages: