The fastest growing segment of the population is the geriatric population. As the baby boomers age and retire, there is more and more demand for health care tailored to the over 70 crowd. Just like pediatric medicine, geriatric medicine requires special attention and knowledge because age affects the way a body reacts to medications and responds to disease processes. When it comes to treating pain in those who are older, a few common complaints are often heard. Here are some common complaints and simple suggestions to overcome these barriers to pain relief in the geriatric population.
“I don’t want to get hooked on drugs”: This generation really can have a fear of being “hooked” on drugs. Maybe being dependent on anything, especially medications, triggers that fear, or maybe the individual knows a sad story about how addiction has ruined another’s life; whatever the reason, many elderly people express a fear of being “hooked”. As a result of that fear, many do not want to take “anything strong”. Often time, this complaint can be addressed with some education about the definition of addiction versus dependency and education about the goals for using pain medications. Once the fears diminish, treating pain successfully with medications does not sound like such a scary treatment plan.
“I can’t use anti-inflammatory medications”: By this time in one’s life, the effects of aging has usually caused high blood pressure or weakened the kidneys or stomach lining. At that point, the use of anti-inflammatory medications may not be a good idea. Unfortunately, this is also the time of life when arthritis is at its worst when anti-inflammatory medications would help the most. So the geriatric population is stuck between a painful rock and a medical dilemma; a good time to consider alternatives like topical anti-inflammatory medications that have little affect outside of the local area where applied. Another option is the lidocaine patch that can help numb away localized pain. Many other alternatives to anti-inflammatory medications exist including an anti-inflammatory diet. When you cannot use an anti-inflammatory medication, it is time to think outside of the Advil bottle.
“I won’t use a walker”: Anytime I mention the “w” word I usually get a scowl and a harsh word or two. The conversation then turns to the typical experience in the grocery store and the fact that most elderly people with back pain feel better when leaning on a shopping cart. Well, shopping carts are not convenient to travel with so why not consider a walker if it means you can walk further with less pain. Or how about trying a walking stick? This is usually hard advice to swallow, but swallowing the pride is worthwhile it when it comes to have a better quality of life.
“I used to be able to…”: Everyone used to be able to lift more, walk more, do more than they can today, now that the years have taken a toll on the body. Unfortunately, using the past as a source of comparison leads to suffering, frustration and depression. It is much better to be grateful for what you can do today rather than ruminating about what you used to be able to do in the past. Adopting an attitude of gratitude is not easy, but sitting around feeling sorry for oneself is no fun either. Sometimes, you can find an alternative way to do something or finding an alternative thing to do. Sometimes you just need to find acceptance for things you cannot change.
“Can’t I just have another shot”: In this day and age, everyone is getting shots to ease the pain. Yes, when you reach a certain age, what is the harm of getting another shot as long as it relieves the pain for reasonable period of time to make it worthwhile. Eventually, the shots can stop working partly because the deterioration gets so bad and partially because the shots become too difficult to get in exactly right place. When the shots do stop working, other treatment options need to be considered like medications.
“Acetaminophen does not work”: Tylenol (acetaminophen) is often overlooked. One reason people disregard it is because it is thought to be an anti-inflammatory that cannot be taken. Acetaminophen is not an anti-inflammatory medication. But most of the time people just don’t give acetaminophen enough of a chance, trying it once and allowing the first disappointment to spoil the entire idea. In my experience, daily use of 2000-3000mg per day of acetaminophen can be very effective when used consistently,but don't press your luck. Many people want to skip ahead to opioid medications without first aggressively using Tylenol.
These common complaints are just a few that frequently are expressed in the geriatric population that is experiencing chronic pain. Not that this generation is full of complaints, but these are just a few concerns that are voiced by the elderly. With a health care provider that is willing to listen and spend the time to explain things, these barriers to pain management can be overcome. Even though elderly people often say that “getting older is not for wimps”, there is no reason to just “tough it out” when concerns and questions arise.
Published On: November 23, 2013