You Don't Have to Live With Persistent Pain
Although many people experience more pain with age, it is not a normal part of life. Here are some tips for identifying your pain and working with your doctor to manage it.
The American Geriatrics Society (AGS) released guidelines on explaining and managing persistent pain. This term refers to pain or discomfort that continues for an extended period of time. Pain may come and go for months or years. Persistent pain can lead to further problems including ]]>depression]]> , social isolation, disability, difficulty walking, sleep problems, and diminished appetite. However, there are ways you can reduce this pain.
Identifying Your Pain
The first step is to keep track of your pain and tell your doctor about it. To give a clear explanation of what you are feeling, write down details about the pain, such as:
- Where it hurts
- How often it hurts
- How much it hurts
What the pain feels like, for example:
- Burning pain
- Sharp or dull pain
- Achy pain
- Pins and needles
- "Shooting" through the body
- What makes the pain go away
- What causes the pain to worsen
- What medications or treatments have been tried, how well they have worked, and what side effects (if any) they may have caused
The AGS has created a "Pain Diary" to help you keep track of this information. This involves using a scale of 1-10 to rate the severity of pain, as well as recording the pertinent information listed above. You should bring this diary to all your medical appointments. This information will help determine the best way to manage your pain.
For a copy of the AGS pain diary, click here .
Understanding Pain Medications
Many medications are available to help treat pain, these include over-the-counter pain relievers and prescription pain medications.
Over-the-counter Pain Relievers
If you have mild to moderate pain that lasts for only a few days, over-the-counter products are both safe and helpful. However, if your pain is severe or lasts longer than a few days, you might need a prescription drug for relief.
There are two main categories of over-the-counter pain relievers:
- ]]>Acetaminophen]]> (eg, Acephen, Genapap, Tylenol)—These drugs can be very helpful for mild to moderate pain caused by musculoskeletal conditions, such as ]]>osteoarthritis]]> or ]]>low back pain]]> . If you need to take acetaminophen for more than a few days at a time, tell your doctor. Also, never take more than the recommended dose, as there is a risk of serious liver damage with overuse of acetaminophen.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)–While generally available without a prescription, these drugs should be taken only after discussion with your doctor. They tend to have more side effects in older people and may also interact with other medical conditions and prescription drugs. Tell your doctor about your use of these drugs and all other medications, both prescription and over-the-counter. Examples of over-the-counter NSAIDs include:
Prescription Pain Medications
Depending on your pain, your doctor may prescribe pain medication. Some common drugs are:
The action of these drugs is similar to that of over-the-counter NSAIDs, but is more selective. Therefore, COX-2 inhibitors are able to relieve pain and inflammation with a lower risk of ]]>stomach ulcers]]> and blood clotting problems.
In 2004, Merck took the COX-2 inhibitor Vioxx off the market due to safety concerns (a small risk of patients having a ]]>heart attack]]> or ]]>stroke]]> ). ]]>Celebrex]]> , another COX-2 inhibitor, also carries the same risk, as well as potentially causing stomach bleeding.
These are drugs that work on the central nervous system to relieve pain. Examples of mild opioids include hydrocodone (eg, ]]>Vicodin]]> ). Strong opioids include ]]>morphine]]> , ]]>oxycodone]]> , ]]>hydromorphone]]> , and ]]>fentanyl]]> . There is some concern that ]]>opioids]]> are addicting. However, the AGS points out that addiction to opioid pain medications is rare in older adults, and this concern should not prevent people and their doctors from trying this option for pain relief.
It is important to know that if you are taking an opioid drug, you should not stop it abruptly. This can cause unpleasant symptoms.
Depending on the cause of your pain, your doctor may prescribe one of these other types of drugs to help ease your discomfort:
Be alert for side effects and tell your doctor about them; there may be better options for you. Some possible side effects include:
- Stomach ulcers
- Easy bruising and bleeding
From NSAIDs or COX-2 inhibitors:
- Kidney problems (more common in older adults)
- Problems with ]]>high blood pressure]]>
- Stomach bleeding
- Contribute to heart attack and stroke
From opioid medications:
- Initial drowsiness
- Short term memory problems
- ]]>Constipation]]> —For the other side effects, the body usually adapts quickly. But for constipation, you may need to take a stool softener or laxative on a daily basis.
The AGS notes that opioids are often the best choice to relieve pain. The side effects are milder than those caused by traditional NSAIDs or the discomfort of untreated pain.
Trying Other Means to Ease Your Pain
Drugs are not the only way to ease pain. Here are some other options to explore:
- Exercise, including physical therapy and fitness programs
- Use of heat or cold
- Transcutaneous electrical nerve stimulation (TENS)
- Pain management programs (offered at some hospitals or local health centers)
Even if these methods do not resolve all of your pain, you may be able to reduce your pain to a more manageable level. The most important thing is to know that you do not have to suffer. Work with your doctor to find some relief.
The AGS Society Foundation for Health in Aging
American Chronic Pain Association
American Pain Society
Chronic Pain Association of Canada
AGS guidelines on management of persistant pain. American Geriatrics Society website. Available at: http://americangeriatrics.org/ .
Ballantyne, JC, Mao, J. Opioid therapy for chronic pain. N Engl J Med. 2003;349:1943.
Celecoxib. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2008. Accessed August 13, 2008.
FDA public health advisory: safety of vioxx. US Food and Drug Administration website. Available at: http://www.fda.gov/cder/drug/infopage/vioxx/PHA_vioxx.htm . Published September 2004. Accessed August 13, 2008.
Furlan, AD, Sandoval, JA, Mailis-Gagnon, A, Tunks, E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174:1589.
Lo V, Meadows SE, Saseen J. When should COX-2 selective NSAIDs be used for osteoarthritis and rheumatoid arthritis? J Fam Pract . 2006;55:260-262.
McGettigan P, Henry D. Cardiovascular risk and inhibition of cyclooxygenase: a systematic review of the observational studies of selective and nonselective inhibitors of cyclooxygenase 2. JAMA . 2006;296:1633-1644.
Patient information sheet Celecoxib (marketed as Celebrex). US Food and Drug Administration website. Available at: http://www.fda.gov/cder/drug/infopage/celebrex/celebrex-ptsk.htm . Published April 2005. Accessed August 13, 2008.
Portenoy, RK. Opioid therapy for chronic nonmalignant pain: A review of the critical issues. J Pain Symptom Manage. 1996;11:203.
Last reviewed June 2008 by ]]>Marcin Chwistek, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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