Most people are aware that there are different types of pain relievers, but did you know that the benefits and risks of taking them evolve as we age? Here, local experts share vital information about managing pain medications that every older adult and caregiver should know.
When it comes to managing pain, there are a number of medications available both over the counter (OTC) and by prescription. Understanding how these medicines work and what risks they carry can be helpful in choosing the right medication, which is especially important for older adults.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs work by blocking the body’s production of chemicals that cause inflammation. Many people take NSAIDs for muscle and joint pain, as they effectively reduce body aches, stiffness, inflammation, and fever. The most common types of NSAIDs are aspirin, ibuprofen, and naproxen.
The most common side effects of NSAIDs are mild gastrointestinal symptoms, but older adults are prone to more severe side effects – including heart attack or stroke when taking non-aspirin NSAIDs.
According to Dr. Alycia Cleinman, a geriatric medicine specialist with CHI Memorial Center for Healthy Aging, “Patients over the age of 64 years old have a higher risk of side effects from OTC NSAIDs. These include kidney failure, stomach ulcers, and subdural hematomas (SDH), which is bleeding in the brain.” Additionally, Dr. Cleinman says that some prescription medications can increase the risk of gastrointestinal bleeding and SDH. For these reasons, it is important for elderly adults to consult their doctor before taking NSAIDs and to take them only as recommended or prescribed.
Acetaminophen
Acetaminophen works within the central nervous system by blocking the pain signals, which come from injured or inflamed areas of the body, from reaching the brain, effectively reducing your sensitivity to pain. This medication is commonly used to treat minor aches and pains, and it also serves as a fever reducer. Often, acetaminophen is combined with other drugs, such as OTC cold and flu medications and a handful of prescription medications.
“For most older adults, the safest oral OTC medication for pain relief is acetaminophen, provided they do not exceed the recommended dose,” says Angela Tackett, a licensed practical nurse with East Tennessee Pharmacy Services. “This is because acetaminophen is less likely to cause harm such as heart disease, heart attacks, strokes, or kidney damage that are often seen with the use of NSAIDs.” However, Tackett warns that because acetaminophen is metabolized in the liver, it may not be the best choice for people with chronic liver disease, and it is best to consult a doctor before starting any OTC medication.
Prescription Pain Relievers
When OTC pain medications aren’t cutting it, a doctor can prescribe something stronger, such as a higher dose of NSAIDs or acetaminophen or opioid pain relievers. “If chronic pain is limiting an individual’s ability to perform activities of daily living like bathing, dressing, toileting, and eating, they should consider prescription medications,” Dr. Cleinman advises.
Opioids are narcotic pain relievers that block the brain’s ability to sense pain, and they are typically prescribed after surgical procedures or severe injuries. Opioids are monitored closely by the prescribing physician to ensure that they are being used safely, as they can cause gastrointestinal trouble, cognitive issues, and impaired motor skills. Additionally, these medications carry a high risk of addiction and should be taken only as prescribed. For caregivers of elderly adults, Tackett advises, “Ensure that medication is given properly and side effects are documented and reported to the prescribing physician. This will help reduce the risk of mismanagement of medication and ultimately lower the risk of addiction.”
Managing Medications
If chronic pain is limiting an individual’s ability to perform activities of daily living like bathing, dressing, toileting, and eating, they should consider prescription medications.”
As we age, managing medications correctly tends to be more difficult, but the risks of misusing medications also increases. Older adults and their caregivers often have to juggle multiple medications, both prescription and OTC. Additionally, older adults can experience memory loss that makes it difficult to remember whether or not they’ve taken something, which can lead to double-dosing or skipping doses – both of which can be very dangerous. Below are some tips from our local experts that can help.
- Use a weekly pill box to sort out medications and doses. This is particularly helpful for older adults experiencing memory loss who may not remember whether or not they’ve taken their medications.
- Get a caregiver involved to either fill the weekly pill box or administer medications on a schedule. Routine check-ins to ensure that medicines are being taken correctly can also be helpful.
- Keep a notebook to track when each medication is taken to avoid missing a dose or taking extra doses. This is also a good place to note any side effects so they can be clearly communicated to medical providers if needed.
- Many pharmacies offer special pill packaging, sometimes at an additional cost, that combines each dose of medication in a single pack that is printed with instructions on how and when to take them.
- An automatic pill dispenser can be programmed to administer medications at a specific time. Many also feature an alarm that goes off when it is time for a medication to be taken.
There are a lot of things to consider when it comes to choosing the right medication to manage pain, and the stakes are unfortunately much higher as we age. If you or a loved one are experiencing chronic or acute pain, especially at an advanced age, consult a physician to determine the best pain reliever for your individual needs.
Alycia Cleinman, MD
Geriatric Medicine Specialist, CHI Memorial Center for Healthy Aging
Angela Tackett, LPN
Nurse Account Manager, East Tennessee Pharmacy Services (A Morning Pointe Medical Partner)
