What We Know About Aging and Pain

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Do you think that growing older involves experiencing more pain? You’re right.

Research shows that older adults experience more frequent pain compared to their younger counterparts, and they are less likely to receive treatment for that pain. A study by the U.S. Centers for Disease Control shows that approximately 50 million older adults experience significant or chronic pain every year – a result of stiff, aging joints, diseases such as cancer, injuries, and surgeries. And a significant number – up to 40 percent – don’t receive adequate treatment for their pain.

But aging and pain do not have to go hand-in-hand.

A systematic review published in the Journal of the American Medical Association investigates the barriers to pain management for older adults and looks at the treatments that work best. The research was conducted by faculty from Cornell University's Translational Research Institute for Pain in Later Life (TRIPLL). The review includes 92 studies – 35 that evaluated medicines for pain treatment and 57 that evaluated other treatments. Here’s what it found:

• Older adults do not absorb medicines as well as younger people and are less able to flush toxins out of their bodies.
• Patients with sensory or cognitive impairments may not be able to adequately describe their pain to caregivers.
• Doctors often worry about the long-term effects of taking pain medicines, especially if the patient is taking medicines for other chronic conditions such as high blood pressure or diabetes.
• Patients often view pain treatments as “weakness” and view tolerating pain as a sign of strength in older age.
• Patients are less likely to seek pain treatment if they don’t have strong, trusting relationships with their doctors.

The review also lays out evidence-based approaches to managing pain in older adults. First, the review urges patients to discuss options for pain medicines with their doctors. Acetaminophen – sold under the brand-name Tylenol – is the first choice for pain treatment among older adults because it carries the least risk for side effects. The review recommends that non-steroidal anti-inflammatory drugs (NSAIDs) only be used for short periods of time because of risks associated with heart problems, kidney problems, and stomach ulcers.

Non-pharmaceutical interventions can also go a long way in relieving pain, especially when used with pain medicines. The review found a wide range of treatments are effective at relieving pain in older adults: cognitive-behavioral therapy, massage, acupuncture, education programs, tai chi, yoga and other exercise programs. A key is to discuss these options with your doctors and develop a specific plan for pain relief that includes your personal goals.

Lastly, a central finding of the review is that doctors must be proactive in listening to patients’ evaluations of their pain levels and offering a multi-faceted approach to pain treatment. Find a doctor that listens and responds if you report increased pain levels. An effective health care provider can also help connect you to community organizations that support your treatment plan, such as community or fitness centers, exercise groups or alternative health providers.

"Physicians and other healthcare providers should encourage patients to adopt a broad range of treatments to help them manage pain," said Dr. Cary Reid, a geriatrician at Weill Cornell Medical College and director of TRIPLL. "Given many older adults’ concerns about the negative effects of medications, encouraging use of non-drug therapies such as visualization, massage, muscle relaxation and exercise techniques is particularly important.”

The take home message: While pain is common among older adults, there are ways to treat it. Building good partnerships with caregivers and exploring a range of options – medicines, therapies and physical activity – are effective ways to manage pain later in life.