There are many causes of pain in older individuals, such as cancer, arthritis, and muscle pain, all requiring pain medication. In their statement, the American Geriatrics Society Panel says "Clinical manifestations of persistent pain are often complex and multifactorial in the older population. In addition, older people may underreport pain. Concurrent illnesses and multiple problems make pain evaluation and treatment more difficult. Also, older persons are more likely to experience medication-related side effects and have a higher potential for complications and adverse events related to diagnostic and invasive procedures. Despite these challenges, pain can usually be effectively managed in this group."
Opiates
The strongest and most effective pain medications are narcotic opiates. Yet according to geriatrician Diane L. Chau at the University of Nevada School of Medicine and colleagues, some opiates should be avoided altogether in elderly people because of side effects; for example, meperidine--Demerol--should not be prescribed to an older person because it can cause seizures and nervousness. Propoxyphene should be avoided because it proves no more effective than a placebo.
Opiates notoriously cause constipation, which may already cause problems for older people not taking narcotics. Chau recommended preventive treatment against constipation by giving stool softeners and laxatives along with opiates for older individuals.
Older people may also become prone to hallucinations and nightmares caused by opiates, and the drug and the dosage needs careful monitoring by physicians.
The older person may be cognitively impaired before taking the drug, and impairment typically increases with opiates.
Sedation is another factor. Older individuals may take other sedating drugs, such as benzodiazepines, barbiturates and antipsychotics increasing the sedation caused by opiates.
Nonsteroidal Antiinflammatory Drugs
Nonsteroidal antiinflammatory drugs--NSAIDs--are commonly prescribed for inflammatory pain, such as the pain of arthritis or back pain. Yet NSAIDs can be dangerous for the elderly person, leading to stomach ulcers and gastrointestinal bleeding.
In an article about adverse drug reactions in the elderly by Dutch physician L.J. G. Veehof and colleagues, they reported that NSAIDs caused stomach pain in nearly 71 percent of subjects.
The American Geriatrics Society warns that as a person ages, the gastrointestinal toxicity of these drugs increase. If an NSAID must proves necessary, they advise that patients should take it with a gastroprotective drug, such as misoprostol, an H-receptor antagonist or proton pump inhibitor medication.
Over-the-Counter Analgesics
Even medications such as acetaminophen or ibuprofen--taken for moderate pain--can be dangerous for older people who use these drugs frequently and at high dosages. Pharmacy professor Dana A. Brown pointed out in her article on pain management in the elderly that acetaminophen should be used cautiously with patients with liver disease because excessive use can harm the liver.
Corticosteroids
Steroids treat pain and inflammation, but they can also cause sedation and dizziness and increase the risk for elderly people to fall down. In addition, Dana A. Brown says steroids can exacerbate diabetes and hypertension. Older individuals may experience retention of fluids with cortiocosteroids such as prednisone.
Antidepressants
Sometimes antidepressants help alleviate pain. The American Geriatrics Society warns that tricyclic antidepressants have many potential side effects in older people, such as gastrointestinal and cardiovascular side effects.
Muscle Relaxants
Severe muscle pain may be treated with muscle relaxants; however, medications in this class of drugs may be sedating and could have cognitive effects as well.
References
- "Clinical Interventions in Aging"; Opiates and Elderly: Use and Side Effects; Diane L. Chau; 2008
- "U.S. Pharmacist"; Principles of Pain Management in the Elderly; Dana A. Brown, PharmD; June 19, 2007
- "European Journal of Clinical Pharmacology"; Adverse Drug Reactions and Polypharmacy in the Elderly in General Practice"; LJ.G. Veehoff, et al.'; 1999
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