Managing Chronic Pain

Writer: The Vidal Team

Older people are always complaining about pain. It�s just a part of aging � right?

Actually, wrong.

Chronic pain may be common, but it is not a �normal� part of aging and it should be addressed. Chronic pain causes difficulty with daily function and sleep and can even lead to depression.

Long standing pain can cause elevated levels of stress hormones, resulting in damage to other bodily functions.

What is �chronic� anyway?

�Chronic pain� is pain that lasts for long periods of time, and/or comes and goes over long periods of time.

This is in contrast to acute (or episodic) pain, which can be more intense but is expected to go away once the underlying cause is resolved. For example, this could be pain due to a sprain or cut.

Treating acute vs chronic pain

Acute pain is often managed by over-the-counter medications such as acetaminophen (Tylenol), or NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), acetylsalicylic acid (Aspirin), and naproxen (Aleve).

NSAIDs are probably the preferred option for many people who are looking to help address pain; headaches, toothache, muscle pain, etc. However, in most cases, NSAIDs are not appropriate for older seniors to take, especially for long periods of time.

Acetaminophen is generally considered safer than NSAIDs but is thought to be less effective and requires adequate liver function. Careful monitoring of INR is required in those taking warfarin and acetaminophen together.

Limitations to using NSAIDs in seniors

Although they are generally more effective than other alternatives, there are several limitations to using NSAIDs in older populations.

Kidney function: NSAIDs are metabolized by the kidneys, which means that they are generally not appropriate in older adults because kidney function declines with age. In fact if the glomerular filtration rate (GFR, a measure of kidney function) is less than 30mL/min, NSAIDs can cause further kidney decline and should not be used at all.

Blood pressure:�NSAIDS can increase blood pressure and increase overall cardiovascular risk.

In addition, NSAID use may reduce the effect of many common antihypertensive drugs. For people who are taking antihypertensive medications for their blood pressure, NSAIDS can worsen blood pressure control. The hypertensive effect of NSAIDs is dose-dependent, which means higher doses will have a greater effect than lower doses.

However it is a good idea to avoid NSAIDs if there are other viable alternatives.

If there are no other viable options for pain management, those taking NSAIDs should take the lowest effective dose, limit the duration, and monitor their blood pressure carefully while on NSAIDS.

Upset stomach and stomach ulcers:�NSAIDs can cause irritation to the lining of the gastrointestinal tract, resulting in rupture and bleeding.

NSAIDs work to reduce pain and inflammation by blocking the production of prostaglandin, a chemical that promotes inflammation. However, prostaglandins also play a role in protecting the stomach lining from corrosive stomach acid. When these prostaglandins are inhibited, the stomach lining is vulnerable and may ulcerate. Though many people with ulcers are asymptomatic and unaware of their ulcers, they are at risk of developing serious complications such as bleeding or stomach perforation.

If NSAIDs are taken by those with increased risk of ulcers (such as a history of ulcers), it should be taken together with a proton pump inhibitor like omeprazole or pantoprazole to provide some protective effects.

Blood thinners such as warfarin and heparin increase the risk of bleeding if NSAID-induced ulcers occur. For this reason, those on blood thinners are advised to avoid NSAIDs.

Chronic pain and opioid narcotics

Prescription opioids are generally preferred in older adults with severe chronic pain that cannot be immediately addressed. However, they too, have serious side effects that all users should be aware of.

Cognition:�Sleepiness, drowsiness and sedation are common side effects, but usually subside with continued use.

Nausea and vomiting:�Many opioids can make you feel nauseated, although this effect also subsides with continued use.

Dependency:�Opioids can be both physically and psychologically addictive. Psychological addiction refers to a euphoric feeling induced by opioids. Physical dependency refers to an actual adverse physical reaction when exposure to opioid is withdrawn. If opioids are used as directed by the prescriber, the risk of developing dependency is greatly reduced.

Respiratory function:�Breathing is part of our autonomic system, which means we don�t have to consciously put effort into doing it. Opioids can cause respiratory depression, which is having a reduced urge to breathe. At lower opioid doses, it may be inconsequential and not even noticeable. However, at higher doses, it may feel like shortness of breath and conscious effort is required to make sure breathing is continued. Respiratory depression can lead to respiratory failure, where one loses consciousness and passes out due to lack of oxygen. This is particularly dangerous if it happens during sleep. Respiratory failure is the main cause of opioid-induced death caused by overdoses.

Tips to manage chronic pain

Use a 1-10 scale to describe your pain.�Many healthcare professionals will ask you to do the same when assessing your pain level and the effectiveness of your treatment plan. Pain is subjectively perceived and treated accordingly so do not worry about reporting a �wrong number�.

Use a pain diary.�Keep track of your pain levels, treatments, response to treatments and side effects of treatments. This will help to determine the best treatment or combination of treatment for your pain.

Use a combination of treatments.�Many people supplement oral medications with supplements such as glucosamine condroitin and topical treatments such as diclofenac (Voltaren), capsaicin, camphor, menthol, essential oils, etc. Make sure you speak to your pharmacist or doctor first to ensure there are no interactions.

Use one pharmacy for all your medications.�This will help the pharmacist to identify inappropriate combinations of medications. If you must use more than one pharmacy, be sure to keep a list of all your medications to show the pharmacist when filling a prescription at a new pharmacy.

Use non-drug measures.�Some people find stress-reduction therapy, mediation, and other psychological intervention to be helpful in the management of their pain.

Maintain bowel function.�Some pain medications, particularly opiods, can cause constipation. Increasing fluid and fibre intake is not always effective. Consider using a stool softener and occasionally, stimulant laxatives to help maintain bowel movements.

Are you looking for qualified and compassionate Caregivers to help care for a loved one? Download the�Vidal Home Care�mobile app or call 1-888-97-VIDAL.



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