Treating Chronic Pain in the Elderly

Apr 27, 2016

Treating Chronic Pain in the Elderly

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What is Chronic Pain?

The definition of chronic pain may differ from doctor to doctor but is generally described as any type of pain lasting more than 12 weeks. Some doctors will not consider a condition chronic pain until the 6-month mark. The pain is persistent, but may not be completely constant. They are different ways that chronic pain can present itself. It can be mild or agonizing, spontaneous or endless, or inconvenient or debilitating. There is no one way that chronic pain presents itself because every person’s pain is different.

It may have a known origin or it may not. Some of the most common things that chronic pain arises from are an old injury, headaches, joint pain, arthritis, tendinitis, sinus pain, and more. It may have also originated from an unknown source, but that does not mean that you don’t have chronic pain. If you have been experiencing pain for at least three months, then there is a good chance that you have chronic pain. Visit your doctor to determine the best option for you to treat your pain.

Effects of Chronic Pain

Chronic pain can lead to pain that is not just physical, but emotional as well. The experience can be isolating, especially if there is no obvious cause of your pain. People may think that it is all in your head, but, usually, that is not the case at all. Everyone experiences pain differently. Three people may have the exact same medical condition but one may have a dull aching pain, another may have spasms, and the other may have debilitating pain. It just depends on the person and any other conditions that they might have. It is important for you to have a full and complete understanding of chronic pain, as well as people around you so they can support you.

There is often a cycle of pain that occurs with chronic pain. The pain that you are feeling may make it difficult to sleep, or may worsen your anxiety or depression. These factors will then continue to make your pain worse, and the combination of your chronic pain and your fatigue, depression or anxiety can actually deplete your immune system. Because of this, it is important to seek treatment.

Chronic Pain Treatment Options

There are a large number treatment options available depending on your type of pain, any other conditions you may have, and what you are comfortable with. Below are some of the options available for managing your pain. The best thing to do is talk to your doctor, and together you can determine the best course of action to take to manage your chronic pain.

Medications

  • NSAIDs - Non-steroid anti-inflammatory drugs include ibuprofen, naproxen, and aspirin and can often be obtained over the counter. They work well for acute pain, but in some instances, they work well for chronic pain as well. Use caution when taking them for an extended time period because there are potential negative side effects including problems with the kidneys and liver.
  • Antidepressants - Older categories of antidepressants, especially tricyclic antidepressants, have pain-relieving properties that can help with chronic pain in lower dosages than what is needed for depression. They should be taken consistently and not on an as-needed basis. There are side effects, but taking the medication at night and drinking plenty of fluids can usually fight them. Antidepressants may also be a good option if your chronic pain has brought on or worsened your depression.
  • Anti-seizure medications - Also known as anticonvulsants, they can be helpful with certain types of nerve pain such as burning or shooting. Like antidepressants, they need to be taken consistently no matter if you feel pain or not. As with all medications, there are side effects. One of the most common side effects of anti-seizure medications is drowsiness, but it usually lessens with time.
  • Opioids - While they need to be used with caution, opioids can be very effective in controlling chronic pain, but less effective for nerve pain. Opioids include hydrocodone, oxycodone, morphine, and codeine. Long-acting opioids work better and are more highly recommended for long lasting pain than short-acting opioids because they are less likely to create addiction. Constipation, drowsiness, and nausea are common side effects.

Therapy Options for Chronic Pain

Physical therapy

An important element of managing chronic pain is physical therapy. Exercise is essential because some of the problems that arise from chronic pain are a decrease in flexibility and stiffness, and they can be combated through the correct type of exercise. A physical therapist can help determine what the best types of exercise are for you to get the best pain relieving results. They are also trained, so they know how to push you so you won't give up, but not to the point where you overdo it. The point of physical therapy is to slowly build your tolerance and reduce your pain.

Cognitive-behavior therapy

Another important type of therapy is cognitive-behavior because chronic pain affects more than just the body, it affects the mind as well. The point is to help you learn about your pain and understand where the pain in coming from. It also helps you to understand what you can do about your problem and what exactly the role the pain plays in your life. This type of therapy is very beneficial especially if any sort of depression or anxiety has developed or worsened with the chronic pain.

Nerve Blocks

There are also numerous nerve blocks and injections that can be done to help alleviate chronic pain. Some of the most well known are:

  1. Epidural steroid injection
  2. Facet joint injection
  3. Lumbar sympathetic block
  4. Celiac plexus block
  5. Stellate ganglion block

The point of all of them is to reduce or eliminate pain through an injection of a numbing medication into the back or joint where the pain is present. The procedure is often done using an x-ray and contrast dye to ensure the needle is placed in the correct location for the medicine. Often, they are done on an outpatient basis. Some common side effects are soreness in the injection area, temporary numbness, and temporary weakness. If numbness persists, see your doctor.

Chronic pain is a huge part of the lives for the people that have it because it not only affects them physically but mentally as well. There are many treatment options available, and the best thing to do is work with your doctor to determine the best options for you. It is also important to surround yourself with people that understand what you are going through because, as mentioned above, it is both physical and mental. Remember, you are not alone and there are options available to manage your pain.

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Frequently Asked Questions

What are the common side effects of opioids?

There are some unpleasant side effects of opioids that you will want to discuss with your senior’s physician or pain management specialist. They are:

  • Constipation: The elderly and those with conditions affecting the gastrointestinal tract are most likely to suffer from constipation when taking opioids.
  • Nausea and vomiting: Depending on what opioid your loved one is taking, it may take a toll on the gastrointestinal tract, causing nausea and vomiting.
  • Itching: Though this symptom will typically last for just a few days, patients may feel itchy due to the release of histamines triggered by opioids.
  • Respiratory depression: This is a rare symptom, though will be present in an opioid overdose. If you or your senior experience shallow slow breathing when taking opioids, talk to your doctor to determine if medication changes should be made, or if it is stemming from another underlying condition.

Learn more about chronic pain management for seniors by reading about how to treat chronic pain in the elderly.

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So I’m not one to try pain medicines unless it’s a last resort - does acupuncture work for seniors?

We hear you! There are many studies to show that acupuncture can be effective in treating mild forms of osteoarthritis. Essentially, this technique causes an increase in T-cells and inhibits inflammatory cytokines which can result in pain management. Acupuncture may also be useful for those suffering from back pain and headaches. Results can vary, however it is one non-drug option many seniors try frequently.

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