Getting the pain prescription right for America’s seniors

By James Appleby

September was national Pain Awareness Month. And one of the major issues policymakers, healthcare providers, and average citizens alike need to focus on is how to improve pain management among older Americans.

Unsurprisingly, this population experiences more pain than younger Americans. Among active seniors, it’s estimated that 25-50 percent experience persistent pain. For these Americans, finding ways to manage pain without reducing quality of life is essential. Among seniors residing in nursing homes or receiving in-home hospice care, as many as 85 percent experience persistent pain.

Plus, older Americans account for an outsized shared of American drug consumption. People 65 years and older make up just 13 percent of the U.S. population, yet they’re responsible for a full third of all pharmaceutical purchases.

And seniors rely heavily on opioid-based treatments, which are extremely powerful but come with elevated risks of addiction and abuse. Since 2007, the number of opioid prescriptions for patients aged 60 years or older has jumped by nearly a third. That’s double the rate of growth for middle-aged patients during that same period.

Of course, responsible prescription drug use – opioid-based based or otherwise – can be transformative for patients, alleviating chronic pain, speeding up post-operative recovery, boosting emotional well-being, and enhancing cognition.

However, opioid drugs can also cause huge, potentially fatal, problems for seniors. Elderly patients tend to be taking other drugs that can interact with opioids and cause adverse side effects. Their physical frailty exacerbates these problems. And opioid overuse can slow post-surgery recovery and speed up cognitive function decline.

Abuse also puts senior patients at much higher risk of falls, which can cause serious bone fractures and shorten life. In fact, a 2010 paper in the Archives of Internal Medicine found that Medicare patients using opioids were four times more likely to suffer a fracture than enrollees using non-opioid treatments.

These risks are a big reason that the Joint Commission, a national non-profit that certifies healthcare organizations, specifically warns that opioids may not be appropriate for all patients.

The Interagency Pain Research Coordinating Committee, which is run by the federal Department of Health and Human Services, recently published a comprehensive strategy for improving pain management that includes specific steps for helping seniors. Policymakers should heed its recommendations.

Avoiding addiction and overdose requires careful care management and regular dialogue between doctors and their senior patients.

Caregivers need to adopt treatment protocols that can help prevent addiction, such as using drugs with the fewest adverse effects first. Providing non-opioid pain medication before and after surgery can also help.

Likewise, caregivers should embrace proven non-opioid pain management alternatives, such as intravenous acetaminophen and over-the-counter painkillers like ibuprofen. These medications can be just as effective at reducing patient suffering without running the high risks of addiction. And even non-pharmaceutical pain management techniques such as yoga, stretching, massage, or acupuncture can help relive senior suffering.

All courses of treatment should begin with an honest and open conversation between patients and their caregivers about how pain affects them, how they are prepared to deal with pain, and how their ideas can be woven into treatment.

James Appleby is the executive director and CEO of the Gerontological Society of America. This piece originally appeared in The Tampa Tribune.

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