Navigating Chronic Pain In The Golden Years

Empowering seniors to take charge of their pain

Chronic pain is more than just physical discomfort; it impacts mobility, mental health, and overall well-being. For older adults, it can lead to reduced activity, falls, sleep disturbances, and social isolation. As we explore strategies to manage chronic pain, it’s crucial to recognise its far-reaching effects on patients, families, and society.

As the population ages, chronic pain becomes an increasingly prevalent issue, affecting the quality of life for many older adults. To delve into this topic, we sat down with Lai Hui Xian, a Clinical Pharmacist at Pantai Hospital for deeper insights. As a clinical pharmacist, she has a special interest in antimicrobial stewardship, palliative care, clinical nutrition, and geriatric medicine.

1Twenty80: What are some common chronic pain conditions that older adults frequently experience?

Lai Hui Xian:

Chronic pain conditions commonly experienced by older adults include muscle and joint pain, especially in the back, neck and knees), fractures resulting from weakened bones, nerve pain (often described as shooting pain), pain after a stroke, or pain associated with cancer.

1Twenty80: Can you provide information on medication management for chronic pain in elderly patients, including potential drug interactions and side effects?

Lai Hui Xian:

Sure, here are some key points to consider:

• Take it at the right time

Taking the pain medication at the right time is crucial. Elderly patients with chronic pain often need to take painkillers regularly throughout the day. It is important not to delay the scheduled dose because the pain relief effect might wear off before the next dose is due, leading to more pain. Some patients may also be prescribed with pain relief patch that needs to be changed once every few days, hence caregivers should keep track of the date and time of the next scheduled change of patch to maintain consistent pain relief.

• Review effectiveness

Caregivers should keep an eye on how well the pain medications are working and provide feedback to the doctor. This helps the doctor adjust the medication if needed.

• Watch out for potential drug interactions

Most elderly take lots of different medications for different health problems. This can sometimes cause problems if the medications interact with each other. For example, using non-steroidal anti-inflammatory drugs (NSAIDs) along with blood thinners may increase the risk of bleeding. But don’t worry! Just make sure to tell the doctor or pharmacist about all the medications that the patient is taking, and they will tailor the choice of painkillers accordingly to avoid interactions.

• Watch out for potential side effects

Older adults are more likely to experience side effects from pain medications due to the changes in their body as they age. For example, NSAIDs may cause bleeding in the stomach while opioids may cause constipation, nausea, vomiting, and drowsiness (which may lead to falls). Caregivers should inform the doctor if the patient is experiencing any of these side effects.

1Twenty80: How can older adults minimise the risk of adverse effects or complications while using prescription pain medications long-term?

Lai Hui Xian:

• Start low and go slow

Doctors often start lower doses of pain medication for elderly patients and adjust slowly to reduce the risk of side effects. Considering that some elderly patients have reduced body weight due to muscle loss, they may also be prescribed a lower dose of pain medication.

• Follow prescribed dosage

It is important to stick to the prescribed pain medication regimen. Do not take more than what is prescribed. If the medication is for “when required” only, use the lowest effective dose for the shortest duration.

• Be cautious with over-the-counter medications

When purchasing painkillers over the counter, be mindful of the various combination medications that may contain active ingredients like paracetamol to avoid unintentional overdosing.

• Prevent complications

Patients who are on NSAIDs should take them after food to reduce gastrointestinal side effects. They may also be prescribed proton pump inhibitors to protect their stomach. Patients using opioids may experience nausea, which can be managed with antiemetics, and constipation, for which they can be prescribed laxatives. Drinking plenty of water and eating a diet rich in fibre may help with opioid-induced constipation as well.

• Regular communication with healthcare providers

Keep in touch with healthcare providers to monitor the effectiveness and side effects of medications. Avoid self-medication or combining multiple pain medications without consulting a healthcare professional.

1Twenty80: Are there specific topical treatments or creams that are suitable for elderly patients with chronic pain, and what are their potential benefits and limitations?

Lai Hui Xian:

Yes, there are several topical treatments available, such as creams, gels and patches, designed to provide relief for chronic pain in older adults. These treatments may contain ingredients like lignocaine, NSAIDs, capsaicin, methyl salicylate, and even opioids. 

Instead of swallowing a pill, these products can be directly applied to the skin over the painful area. This would potentially cause fewer side effects compared to oral medications. However, some patients might experience side effects like skin irritation (including a burning sensation from capsaicin-containing products) and allergic reactions. Despite these limitations, topical treatments can be an effective and convenient option for managing chronic pain in elderly patients.

1Twenty80: Are there non-pharmacological interventions or alternative therapies that you

recommend for managing chronic pain in older adults?

Lai Hui Xian:

In combination with medication, several non-pharmacological interventions and alternative therapies have been found to be effective in managing persistent pain in older patients.

Cognitive Behavioural Therapy (CBT) focuses on changing thought patterns and behaviours related to pain, helping patients develop coping skills and improve their quality of life. Other than that, acupuncture and massage may provide relief by alleviating muscle tension, improving circulation and promoting relaxation. 

By incorporating these non-pharmacological approaches together with medication, older adults can better manage chronic pain and enhance their overall well-being.

1Twenty80: What role does physical therapy or exercise play in managing chronic pain for elderly individuals?

Lai Hui Xian:

Engaging in regular exercise including strengthening, flexibility, endurance and balance training is highly recommended to strengthen muscles, improve mobility, prevent further muscle loss and reduce pain. Tailored exercise programs include low-impact aerobic exercises, stretching, and strength training.

1Twenty80: Can you offer guidance on nutritional strategies or dietary adjustments that may help alleviate chronic pain in older adults?

Lai Hui Xian:

Consuming an anti-inflammatory diet rich in fruits, vegetables, whole grains, and healthy fats like omega-3 fatty acids may help reduce inflammation and alleviate pain. Additionally, staying well-hydrated and limiting intake of caffeine and alcohol can further support pain management.

1Twenty80: What steps can older adults take to promote overall well-being and quality of life while managing chronic pain, beyond medication and therapies?

Lai Hui Xian:

Hanging out with friends, joining support groups, doing things that they enjoy, and finding ways to relax can improve mood and overall quality of life despite having chronic pain. Maintaining a healthy sleep routine and managing stress through mindfulness or meditation can also positively impact pain perception and overall well-being.

1Twenty80: Is there anything in particular that caregivers should be aware of when caring for those with chronic pain?

Lai Hui Xian:

Caregivers play a vital role in providing support and assistance to elderly patients with chronic pain. 

• Recognise pain

Elderly patients may underreport or exhibit unusual presentations of pain. Caregivers should familiarise themselves with the symptoms of pain and learn how to recognise them.

• Understand their pain condition and its management

Accompanying patients to doctor appointments can enhance understanding and involvement in treatment discussions. Learn about their medications, including administration and potential side effects. Do not hesitate to contact healthcare professionals if you have any questions.

• Help with daily activities and ambulation

Elderly patients with chronic pain may struggle with daily tasks and mobility. Providing physical assistance with grooming, dressing and meal preparation, as well as obtaining appropriate walking aids like a wheelchair, can greatly assist.

• Provide mental and emotional support

Chronic pain often takes a toll on mental and emotional well-being, leading to feelings of frustration, depression, anxiety and isolation. Encourage social engagement, relaxation techniques and hobbies to improve mood. Actively listen to their concerns and seek support from mental health professionals or chronic pain support groups if needed.

By addressing these aspects, caregivers can provide comprehensive support to the elderly with chronic pain, promoting their overall well-being and quality of life.