Pain Management in the Elderly

October 6, 2021

Despite high levels of pain in those 65 and older, overall this condition remains to be undertreated. This may be because those with dementia related illnesses fail to properly communicate their pain issues due to either cognitive or linguistic impairments. Even the seniors who do not face cognitive issues may decide not to discuss certain pain symptoms because they do not think anything can be done to correct the problem.

Caregivers need to be proactive in discovering potential ailments and sources of pain in those they are providing care and assistance. Relaying the information to healthcare providers can lead to a referral to special pain management physicians. These physicians can offer various medications or holistic options to ease some of the pain.


Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature. Most people are familiar with over-the-counter, nonprescription NSAIDs, such as aspirin and ibuprofen. Pain management professionals will often suggest the use of NSAIDs for musculoskeletal pain in the elderly. Even these over-the-counter drugs must be given under the care of a healthcare professional because they have serious side effects in the elderly.

NSAIDs are a common culprit of hospitalizations due to drug-to-drug interactions. There are many adverse drug reactions for those with heart or renal issues and those taking gastro-protective drugs. Prescribers must be very attentive to each patient’s medical history and list of medications, whether over-the-counter or prescription.

Adjuvant Analgesics

Antidepressants are the most commonly prescribed form of adjuvant analgesics in the elderly. These assist in pain management by addressing neuropathic pain. Neuropathic pain may occur if your nervous system is damaged or not working correctly. You can feel pain from any of the various levels of the nervous system—the peripheral nerves, the spinal cord and the brain. Examples include post herpetic (or post-shingles) neuralgia, reflex sympathetic dystrophy / causalgia (nerve trauma), components of cancer pain, phantom limb pain, entrapment neuropathy (e.g., carpal tunnel syndrome) and peripheral neuropathy (widespread nerve damage).

These antidepressants can result in loss of equilibrium making the elderly more prone to falls. It can also decrease blood pressure, cause sleep disturbances and arrhythmias. However, many seniors find that they do help with neuropathic pain. The benefits may outweigh the side effects in many cases.


Opioids such as morphine, oxycodone, fentanyl and methadone do work well to relieve pain; however, they are highly addictive. The risks versus the benefits should be weighed prior to going down this path. If the senior has a history of addiction, it is often wise to avoid any opioid treatments.


Acupuncture is becoming a more widely used form of non-medicinal treatment for pain. Originating from traditional Chinese medicine, acupuncture involves the insertion of very thin needles through your skin at strategic points on your body. Many Western practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. Some believe that this stimulation boosts your body's natural painkillers. The mindset and belief in its pain-relieving ability may also contribute to the patient’s improvements.

Chiropractic Care

Chiropractic care is a method of hands-on treatment that can help seniors attain general wellness and lasting pain relief. By improving flexibility, aligning the joints, and alleviating tightness in the muscles, chiropractic treatment may allow seniors to move with ease.

Medicare Part B will cover 80% of spinal manipulation provided by a chiropractor if it is determined to be medically necessary.

At Stouffer Legal we care about our seniors and recognize that proper pain management is foundational to enjoying the later years of life. For more information on elder law issues or to develop a long-term care plan, contact our elder law attorneys for a consultation. You can schedule an appointment by calling us at (443) 470-3599, emailing us at, or register for an upcoming free webinar using the link below:

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