Researchers Focusing on Pain Management in Elderly

Researchers Focusing on Pain Management in Elderly

By Staff.

Elderly people present a unique series of challenges to health providers with respect to managing pain.

“Pain is prevalent and often undertreated among older adults,” said Robert Gatchel, UTA Distinguished Professor of Psychology, Nancy P. and John G. Penson Endowed Professor of Clinical Health Psychology 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,” he added.

In a new review paper published in the EC Anesthesia Special Issue 2017, Gatchel and UTA psychology doctoral student Kelley Bevers analyze the challenges of using opioids, anti-depressants, anti-inflammatory drugs and topical and injectable agents to treat pain among the elderly.

“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.”

The review also analyzes concerns about using anti-depressants for pain relief among this population. Cognitive impairment such as dementia or Alzheimers can affect the adherence to and consistency of the consumption of anti-depressant medications among older populations. An erratic or sudden cessation of medication can lead to complications such as suicidal thoughts or behaviors, depression or mood imbalances. In addition, other medications that the patient may be taking such as steroids, hormonal supplements and anticonvulsants can exacerbate or worsen these depressive symptoms. Gatchel suggests that a thorough medical history needs to be considered prior to beginning antidepressant treatment among this patient group and detailed follow-up is needed.

Another widely used pain medication group are non-steroidal anti-inflammatories sold under well-known brand names such as Advil, Motrin or Aleve. While these drugs are effective for treating musculoskeletal pain, they pose challenges for use in older adults, including drug interactions with certain medications such as aspirin and selective serotonin reuptake inhibitors, commonly used to treat depression, as well as increased risk of peptic ulcers and compromised organ function when taken over the long-term. Gastro-protective drugs can reduce the risk of ulcers and toxicity, but are currently only being prescribed in about 40 percent of older patients taking anti-inflammatories, per a nationwide register-based study.

“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.”

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Authored by: Staff

There are 28 comments for this article
  1. Tim Mason at 7:46 am

    Going forward I am going to use the word “Intractable Pain” in place of Chronic Pain to describe the state of my pain.
    To me it is a more fitting description and actually removes some of the stigma associated the chronic pain term.
    Although the terms are interchangeable, saying Intractable gives a more descriptive meaning of the scar tissue on my lumbar nerves that no surgeon that will see me and offer any surgical procedure to correct my problem without making it worse. This includes the Spinal Cord Stimulators that, according to Dr. Tennant, can in fact make the problem worse.
    Furthermore, the more surgeries one has the least likely it is that a neurologist can tell exactly where the pain is coming from.

  2. Tom at 6:47 am

    I have been on strong pain meds since 1989 such as female 100 Fentanyl patches 100mg, morphine 30mg, morphine 100 mg. Oxycodone 30mg. Oxycontin 80mg and a hell of a lot more. But now i just take 100mg morphine and Oxycodone30mg. And i have a job thanks to my doctor who was more concerned about me then money and the Dea.

  3. Notasheep at 10:00 pm

    Patricia,

    That’s all most as bad as the pain. The dirt and clutter that now exists in our homes. I wondered if I was the only one who literally is sicked by my former immaculate home……..it was so beautiful and I was so proud,….

  4. Cynthia Arthur at 7:43 pm

    I appreciate and agree with your article. I am 51 and have dealt with chronic pain for 20 years now. The medications I’ve been on and the information I’ve attained on social media have confirmed my concerns regarding medications/age and the fact that it can do damage and should be closely monitored due to that fact alone ! The Dr’s do not seem to be as concerned about your health/organs and the possible effects of medication & the damage it can do. They do not test my liver, kidneys, gastric etc.. I’m beyond frustrated and saddened by the fact that ‘pain management’ has become seemingly less than important and appears to be all about the money and giving Doctors an extremely hard time re: being involved any longer in out pain management ! Again, Thankyou for sharing this information !

  5. Kathy C at 6:21 pm

    Most of the Elderly Deaths from all Pharmaceutical Products go uncounted, they are attributed to “Underlying Condition.”. The elderly risk dying from PolyPhamacy, an area this Researcher is either unaware of or deliberately left out of the “Research.” In some of the Elderly even a Blood Pressure pill can be deadly, they can lose balance and fall, due to sensitivity to the Medication. This kind of Information is not only inconvenient, it shows how little “Research” they are doing. They rely on Pharma for their funding, so they have to write Articles like this. They are designed to mislead the public and give the appearance of doing actual “Research.” In Post Fact America this carefully scripted Industry Public Relations goes a long way.

  6. Davis Stapp at 2:50 pm

    I curious if any studies have been done to see if appropriate CBD’s treatments (non THC element extracted from canibis) aid in elderly pain management. The long term side effects of the pharmaceutical meds listed will kill you. Studies in Israel and outside of the U.S. have shown positive results using CBD’s for treatment for the types of conditions also mentioned in the article.
    Blessings

  7. David Cole at 2:15 pm

    Why must you people always bash opiates, I have neuropathy if anybody was going to fall down it would be me. After 8 years taking them I don’t get dizzy, I don’t get woozy, I don’t get high. Why can’t you just give us what the hell we need and leave us alone so we can die in peace.

  8. Debbie Helfrich at 1:02 pm

    With the baby boomers age amongst us it’s difficult to see a pain mgmt Doctor without waiting months and months.

  9. Linda at 8:52 am

    Should all be pretty common knowledge amongst physicians I would imagine. If I know it, surely doctor do. Nothing new here.

  10. James Dickson at 5:01 am

    I am a 71 yr old veteran with 65 yr old wife. My arm was shattered requiring 2 surgeries when our ceiling flooded and collapsed on top of us in a Miami Beach rental.
    After a monster of a doctor refused to write scripts so I could live with my severe pain, I found a compassionate doctor who writes appropriate prescriptions for my genuine medical condition. In today’s “opioid environment” where everyone seems to be attacking this God-given pain relief, real patients may be ridiculously considered addicts- extremely unfortunate for the suffering, as many doctors are afraid, refusing to write prescriptions.
    Chronic pain patients are turning to medical marijuana, outrageously expensive and not covered by ANY insurance. The huge media campaigns against all opioids, grouping heroin and cocaine with legitimate prescriptions, seems a mass manipulation toward Marijuana therapies; now we must learn who invested in and control this industry. Follow the money, not quality of patient care.

  11. Vickie goddard at 3:34 am

    I feel us older people over 60 the injection work on Ali people myself included I honestly have to say do the physical therapy is a lost .I was injured doing those I I need is a miled pain pill to keep me comfortable it’s good to see someone cares about us just let us live out our days comfortable and we all can be happy signed hope

  12. Derek Saloman at 10:22 pm

    Americans are facing some very complex issues respective to pain management. There are a wide variety of secondary problems effecting the system, and how patients are ultimately provided treatment. The opioid epidemic has compounded these issues, and with many doctors accepting false claims and perceptions about certain DEA mandates, only those law abiding, truly sick patients will suffer unnecessary consequences. Irresponsible medical practitioners have created a large percentage of patients who’ve evolved beyond some 90 day or less time frame for acute injuries or surgical recoveries creating a new problem wherein a patients body evolves physiologically becoming reliant on a new functional normal associated with opioid use. As this nasty cycle continues, some become mentally or physically addicted; but all come to need the medication to avoid sickness and withdrawals. Even more irresponsible is doctors who allow such use to continue and then suddenly stop the patients refills. Now patients are forced to seek help from other doctors or seek unlawful alternatives which sometimes includes taking illegal hard drugs to avoid the serious consequences of sudden opioid withdrawal. This risk greatly increases with patients who have underlying health conditions. Self medicating becomes a succession of how people develop reliant or addicted to medications. Another sub component of the overal issues include medical marijuana use. There are legitimate reasons for using medical marijuana. Unfortunately, there are States where doctors are signing for 20 year old’s describing any level of pain, and soon you have a young adult legally using and likely sharing a drug which effects driving, decision making, and that some consider to be a gateway to other drug use. As these issues generate consequences there is a systemic effect that ripples across the Country. There are some serious diseases with very painful side effects and those who truly deserve treatment should not suffer for the stupidity of people who know better.

  13. Jean Bouska at 5:41 pm

    I am nearly 72 have recently had a lower lumbar àblation . The procedure is fabulous but the muscle spasms are still there but personally I feel like it be a suceed once the muscles get used to being able to be used pain free except for being weak due to being tight for so long . Thanks to my pain management team at Summit Orthopedic

  14. Patricia Howard at 5:35 pm

    Chronic Pain since January 1st 2009! 25++++ spinal injections, radiofrequency, Rotator Cuff, Relocation of ulnar nerve! An 8 yrs of injections for arthritis in both hands this md did prescribe Vicodin! Thank God Fo Him!!!!! This excludes the 25+++++ outpatient spinal injections with Steroids!!!! No Sleep for 9 yrs !!! This was all caused by severe reaction to Leviquine Dec 2008!! end of dec is when rashes, pain, back, arms, My last spinal radiofrequency was Nov 6th 2017!!!! Md nothing to relieve chronic Pain! So iv been taking “”6″” Aleve pm at nite! An no relief an speeding inside from sooo much steroids! Didn’t concern M.D. that I can be bleeding internally!!!!! Dogs are treated better!!!! I cancelled my right side for lower lumbar radiofrequency! He should be concerned about left lower lumbar! No change! Worst! Can’t stand in one spot! Or stand in shower, but have to! I just keep saying Ouch!!!! Not Fair that I lost 9 Years of my life! 66 years young! I would be happy to take 1/2 of Vicodin TID!!!!! Our Home is So Dirty!!!!!! I never lived like this!!!! An wouldn’t wish on anyone!!! M.D. are paranoid to give relief to Chronic Pain O! Have Chronic COPD since 1987!!! On nebulizer 1 year now! How Swell! Screw Big Brother! FDA!!!!! Dictating My needs. Pain management won’t work!!!!! Just Not Fair to all! An Me!

  15. Ronald Lankford Lankford Sr at 4:43 pm

    After 65 drs dont see you as anything but a $. Took wife to a RA DR. He told us he did treat pain. Took her to a pain DR. all he would offer was. Steriods. She has diabetes & they dont work good with Steriods. Raises Sugar level. These were WAKE. FOREST BAPTIST DOCS. Where is the help for us old folks. There is. None. The gov and medical. Community are going out of their way to help a bunch of drug addicts. The dont get better.

  16. Tim Mason at 4:36 pm

    I am glad to see an article about my people. Many falls occur late at night when we get up to urinate. The dog steps to allow our aged pet to get in an out of bed are often over looked when returning to bed. I keep a gallon size urinal by my bed, I also keep a flashlight and nightlights by the bed and in the restroom.
    Elder abuse is REAL. Theft of narcotics is common. I try and keep honest people honest and lock my medication up and even move them around.
    Those that steal pain medications of hurting old people and those with Parkinson’s Disease have a special seat in Hell.

  17. Princella Baker at 4:23 pm

    The geniuses think that the older you get you can handle a migraine they think because you have lived to be 80 if you break a bone or two your nerve endings feel nothing they salute your severe pain BS and more BS

  18. Byron at 3:32 pm

    I will post again, for the umpteenth time::

    Every chronic pain patient needs to be VERY concerned about HR 4482, the Meadows-Renacci “Opioid Abuse Deterrence, Research, and Recovery Act of 2017” https://www.congress.gov/bill/115th-congress/house-bill/4482/committees?r=6 .

    Contact your US Representatives, especially members of the Energy & Commerce Committee https://energycommerce.house.gov/about/ and Judiciary Committee https://judiciary.house.gov/wp-content/uploads/2017/12/115th-House-Judiciary-Committee-Updated-120517.pdf .

  19. Cynthia white at 2:25 pm

    Ian absolutely appalled at what the opioid problem has done to the innocent,Mainly upon elderly who are in private facility, I am disabled but worked in this private adult care home,care is top notch there, the owner has dedicated many years for patients,to make sure there stay is comfortable, warm,an like home, recently,hospice group that provided services there, came in cutting the 2 patients,which were on loratab5s,an controlled dispensing by highly trained caregivers, has came in cut meds, pain meds,in half to wean them off, these two ladies are in there 80s an deserve co.fort in the last days to be comfortable it just disgust me that this is what has become

  20. Ellen at 2:03 pm

    Elderly people such as I and others who have back surgeries gone bad cancer of the lung are not treated because of the younger generation and their overdosing.I think it’s a shame that the elderly get cut off their pain meds because of those abusing them.

  21. Billy D. Garner at 10:06 am

    Seems that once an individual reaches 65 years old, they are of no consequence anymore. The old saying now applies, “Old and in the way”. We are thought of as no longer a meaningful part of society . So our social security is stolen by the federal government and we are shoved into some obscure corner where we are left to fend for ourselves the best we can. Always being promised, yet never receiving. Have the people of this land forgotten that people my age and older are are the ones who built them a country where they can have the opportunities they have. ” That is Love and gradatude for you” each day that goes by the light of our hope grows less.

  22. kandace frye at 10:06 am

    I’m 50 w/ health conditions of a 70 yr old! Told I’m too young to have these problems. It’s genetics not my fault. Hla b27+

  23. Jill at 10:03 am

    This is a subject that needs this type of serious recognition. Dealing with chronic pain at mid seventies is way more complicated than when I was younger. And mentally the challenge increases every year, with end of life so clearly in view. It’s especially alarming how trusting the elderly can be with their doctors at a time in medicine where every treatment needs to be scrutinized and carefully researched. Getting older is not for wimps. Getting older with additional chronic pain issues is for warriors.

  24. Ray monette at 9:13 am

    This article clearly shows the need for all elderly patients to have a Geriatric doctor, because these issues are exactly what they cover.Also, i find it hard to believe that anyone using nsaids often doesn’t at least buy over the counter Zantac or or similar to protect their stomach.

  25. Larry at 9:05 am

    I’m a 62 year old man with MS and if anyone has this you would be screaming for medication to. I promise you would so help us legitimate sick people along and worry about the abusers only . Thank you.

  26. Michael G Langley, MD at 7:54 am

    Since chronic use of NSAID-s can increase the incidence of MI, I refuse to take them daily. Opiods, by the way, cause no liver problems, either. The Tylenol is the one that causes that! You can bet we will be losing more of our pain relief!

  27. Janice Poole at 7:53 am

    I think this is being over analyzed. If you asked any elderly patient what is MOST IMPORTANT to them, first and foremost would to be out of pain REGARDLESS of the negative consequences of falls, etc. They world rather fall and die and be out of pain than live an excruciating life of unending agony!

    Most Dr.’s and nurses and people who look after the elderly in nursing homes, could care less about them (I know because I’ve seen it first-hand), so to think that they are going to weigh and take into consideration all of the things mentioned in your article is a pipe dream!

    Most want to put them on strong anti-psychotic medications to render them unconscious so they don’t have to bother with them! And there is a lot of abuse going on which sees little Media attention. That’s the reality unfortunately! So I mean no disrespect to the staff, but when I see articles like this, I think someone is sitting in an ivory tower completely removed from reality! If only physicians, nurses and techs went into their careers motivated by compassion and a desire to help, instead of greed or this is the best job to find employment in, then maybe this would be relatively. Sadly, that’s not the case.

  28. Gabriel J Guidry III at 6:55 am

    It’s about time someone spoke up on this very important issue. It seems the older one gets the less attention is given to the age group, by the medical and government establishment.

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