Pain Management in Older Adults Can Be Challenging
In a new study, researchers analyzed the challenges associated with prescribing opioids, antidepressants, anti-inflammatory drugs, and topical and injectable agents to treat pain in elderly patients.
Their findings are published in the EC Anesthesia Special Issue 2017.
“Pain is prevalent and often undertreated among older adults,” said Distinguished Professor of Psychology Robert Gatchel from the University of Texas at Arlington (UTA) and director of UTA’s Center of Excellence in Health & Chronic Illness.
“With 20 percent of Americans expected to be 65 or older by 2030, the development of new and effective pain management strategies is a necessity, especially given that 75 percent of people in this age group have two or more chronic conditions such as heart disease, arthritis, or diabetes, which complicate the taking of pain medications.”
Gatchel conducted the study with UTA psychology doctoral student Kelley Bevers.
“The side effects of opioids, such as nausea and dizziness, can lead to an increased risk and rate of falls and subsequent injury, particularly among the older population,” Gatchel said. “Older adults are also more prone to physical side effects from these drugs, such as liver and kidney problems, and need both careful evaluation and routine testing of organ function for follow-up care.”
In the review, the researchers also addressed concerns regarding the use of antidepressants for pain relief among this population. Cognitive impairments such as dementia or Alzheimer’s disease can affect the adherence to and consistency of the consumption of antidepressant medications among older populations. Importantly, an erratic or sudden cessation of these drugs can lead to severe complications such as suicidal thoughts or behaviors, depression, or mood imbalances.
Furthermore, other medications that the patient may be taking such as steroids, hormonal supplements, and anticonvulsants can exacerbate or worsen these depressive symptoms. Gatchel says that an elderly patient’s medical history needs to be thoroughly reviewed prior to beginning antidepressant treatment and a detailed follow-up is needed.
Non-steroidal anti-inflammatories sold under well-known brand names such as Advil, Motrin, or Aleve, may also pose particular challenges for elderly patients. While these drugs are generally effective for treating musculoskeletal pain, they may poorly interact with other medications such as aspirin and selective serotonin reuptake inhibitors, commonly used to treat depression. They may also lead to an increased risk of peptic ulcers and compromised organ function when taken over the long-term.
And while astro-protective drugs can lower the risk of ulcers and toxicity, they are currently only being prescribed to around 40 percent of older patients taking anti-inflammatories, according to a nationwide register-based study.
Topical creams, transdermal patches, or injectable medications are another option for elderly patients unable to take medications in pill form or who suffer from acute, localized pain. Topical creams can be effective for pain near the body surface such as superficial muscular pain but may not be sufficient to penetrate the body for other conditions.
The review states that morphine can be administered in patch form allowing for a steady release and absorption of the medication without the need for an intravenous setup or oral medications. Other medications are also available in injectable form, but are usually reserved for emergency situations.
“Pain management in older adults is a complex and multi-faceted issue,” Gatchel concludes. “Older adults face unique challenges that can further complicate general concerns, so complete medical histories including current medications are essential for effective and safe pharmacotherapy. Each major medication group presents advantages and complications to pain management and must complement other medicinal needs, so thorough screening is essential.”
Source: University of Texas at Arlington
Pedersen, T. (2018). Pain Management in Older Adults Can Be Challenging. Psych Central. Retrieved on July 3, 2020, from https://psychcentral.com/news/2017/12/23/pain-management-in-older-adults-can-be-challenging/130357.html