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by Keela A. Herr, PhD, RN, (Member)
and Bruce A. Ferrell, MD (Chair)
AGS Expert Panel, The Management of Chronic Pain in Older Persons
Chronic pain is pain or discomfort that lasts
more than three months. With some conditions, pain can come and
go for months or years. But, there is good news! There are many
treatments that can help manage chronic pain.
Often, chronic pain limits one's ability
to enjoy life to the fullest. Some of the problems it creates
include depression, disability, difficulty walking, and trouble
sleeping.
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Q. Isn't chronic
pain just part of growing old?
A. No.
Chronic pain is not normal. It is common, but it is not normal
or expected with aging.
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Q. What can I do to
best communicate my pain to my doctor?
A. Talk to
your doctor or health care provider about your pain. Doctors cannot
understand how you feel unless you tell them.
Here is what your doctor needs to know:
- Where it hurts;
- How often it hurts;
- How much it hurts;
- What the pain feels like (Does it burn? Is
it sharp or dull? Does it ache? Does it feel like pins and needles,
or does it "shoot" through a part of your body?);
- What makes the pain go away or;
- What makes the pain get worse; and
- What medications or treatments have been
tried, how well have they worked, and what side effects (if
any) they caused.
Q. What is a pain diary
and how can it help?
A. A pain
diary is simply a record of the pain you have felt. You can use
a notebook or sheets of paper to create this diary. In this record,
you can write down important information, including: when you
felt pain, what type of pain you felt, the location of the pain,
what you did for the pain, and how it may or may not have helped.
A pain diary can help your doctor establish a diagnosis and treatment
plan.
Q. Can I take 'over-the-counter'
medications for pain?
A. Ask your
doctor or other health care professional. Over-the-counter pain
medications are safe and helpful for mild to moderate pain for
a few days. For severe pain or pain that lasts longer than a few
days, you should talk to your doctor or health care provider.
If you are already taking prescription medications, you want to
be sure there are no interactions between over-the-counter medications
and your prescription drugs.
Q. Can you explain
what over-the-counter medicine is best to use?
A. Acetaminophen
(Tylenol, for example) may be the best choice for mild to moderate
pain caused by musculo-skeletal conditions, such as osteoarthritis
or low back pain. But if you take acetaminophen for more than
a few days, you should talk to your doctor or other health care
provider. Non-steroidal anti-inflammatory drugs (NSAIDS), such
as aspirin or ibuprofen, may have more side effects in older people.
These drugs may also interact with other medical problems and
prescription medications. They should be used carefully, especially
when they are taken at the highest dose or over long periods of
time. It is important to always tell your doctor about all the
over-the-counter medications you use.
Q. Will I get addicted
to pain killers?
A. Acetaminophen
(such as Tylenol) and NSAID drugs (such as aspirin and ibuprofen)
are not habit forming. Opioid pain medicines (such as codeine,
Vicoden, Tylenol #3, Percocet, and others, including morphine)
can cause side effects if stopped suddenly, but addiction is very
rare among older people. The risk of addiction has probably been
overstated.
Q. Can I expect side
effects from medicines that relieve pain?
A. All medicines
may cause side effects.
- Acetaminophen is an ingredient in many over
the counter and prescription medications. If you take several
medications, you can get too much. If you are unsure, ask your
pharmacist or doctor.
- NSAIDS in high doses for long periods of
time can cause indigestion, stomach ulcers, easy bruising or
bleeding. They can also make kidney function worse.
- Opioid medications can cause initial drowsiness
and constipation, and they can be habit forming. However, they
may be the best choice, since side effects are less serious
than those from NSAIDS.
Remember, medicines are intended to help you!
If you have any concerns about side effects, speak to your doctor.
Should a medicine cause side effects, tell your doctor. There
may be other medicines or treatments that might work better for
you.
Q. My health care provider
suggests that I take antidepressants for my pain. Does this mean
the pain is just in my head?
A. No! Research
has shown that some antidepressant medications can help relieve
some types of chronic pain. Other medicines known to help certain
kinds of pain include anticonvulsant drugs [such as Tegretol (carbamazepine)
and Neurontin (gabapentin)] and local anesthetics, such as lidocaine.
These drugs seem to be most effective against chronic pain associated
with nerve injuries and nerve diseases (neuropathic pain). Ask
your doctor or other health care provider to explain the medications
you are taking.
Q. What can I do besides
taking medications?
A. There are
many things you can do. The more you know about your pain, the
more you can do to control it. There are programs and specialists
that can teach you about pain and how to cope with it. Ask your
health care provider about programs in your area. Exercise is
also extremely important. Ask about appropriate physical therapy,
exercise, or fitness programs to improve physical strength and
maintain endurance. Other non-drug treatments include the use
of heat, cold, relaxation techniques, massage, and distraction.
Acupuncture, transcutaneous electrical nerve stimulation (TENS),
and chiropractic methods may help some people. It is important
to ask your health care provider about the usefulness of these
treatments for your specific problem.
Q. What if my pain
is not relieved?
A. Don't give
up! Ask your doctor or other health care provider for a referral
to a pain management center. Some chronic pain problems are extremely
complex and require a team of specialists to diagnose and manage
it. Although you may not get complete relief of all pain, much
can be done to control or manage most chronic pain problems.
Q. Where can I get
more information about chronic pain management?
A. The Foundation
for Health in Aging; Eldercare at Home, Chapter 11 "Pain" www.healthinaging.org/eldercare/chap11.html
The American Pain Society 570 Old Orchard Road,
First Floor, Skokie, IL 60077-1057, 708-966-5595
National Chronic Pain Outreach Association (NCPOA)
7979 Old Georgetown Road, Suite 100, Bethesda, MD 20814-2429,
301-652-4948
American Chronic Pain Association P.O. Box 850,
Rocklin, CA 95677, 916-632-0922, www.theacpa.org
Arthritis Foundation 1330 W. Peachtree, Atlanta,
GA 30309, 1-800-283-7800, www.arthritis.org
National Headache Foundation 5252 North Western
Avenue, Chicago, IL 60625, 1-800-843-225
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