Chronic pain is common in older people. A recent Louis Harris telephone survey found one in five older (18%) Americans to take analgesics regularly (several times a week or more) and 63% of those had taken prescription pain medications for more than 6 months. Older people are more likely to suffer from arthritis, bone and joint disorders, back pain, cancer and other chronic conditions for which analgesics are used.

Acetaminophen (Tylenol™) is the most widely used over-the-counter analgesic. It is generally very safe at recommended doses and interacts with relatively few medications. It is most useful for pain without inflammation since it does not have any anti-inflammatory effects. Depending upon the condition, many older people may not have adequate pain relief despite using optimal doses. The maximum dose per day is 4 grams or 4000 milligrams. Overdoses or long term chronic use of Tylenol™ may result in liver toxicity.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) provide relief in conditions where inflammation is present, such as rheumatoid arthritis or osteoarthritis. The risk of bleeding associated with the use of NSAIDS in the older population is higher than that of the general population therefore the risks and benefits should be weighed carefully against other available treatments. Over-the-counter NSAIDS include ibuprofen (Advil™), naproxen (Aleve™) and ketoprofen (Orudis KT™). Examples of NSAIDS available by prescription only include ibuprofen (Motrin™), naproxen (Naprosyn™), ketoprofen (Orudis™), sulindac (Clinoril™), indomethacin (Indocin™), ketorolac (Toradol™), nabumetone (Relafen™), and piroxicam (Feldene™). Piroxicam should not be used in the elderly because it takes a long time to be eliminated from the body and it has a higher incidence of gastrointestinal bleeding. Ketorolac is only indicated for short-term (1week) use. Ketorolac and indomethacin should also be prescribed cautiously in the elderly because of bleeding. All of the NSAIDS should be taken with food to prevent upset stomach, bleeding and ulceration. Other side effects include drowsiness, dizziness and renal impairment.

Aspirin is one of the oldest pain relievers available over-the-counter. It has good activity against inflammation and it is inexpensive. The disadvantages though, are its propensity to cause bleeding and ulceration and in larger doses may cause tinnitus or ringing in the ears. It should not be given with other NSAIDS due to the increased risk for bleeding. It should be taken with food or after meals. Patients who are allergic to aspirin should not be prescribed NSAIDS due to cross-reactivity between the two classes.

Narcotic analgesics include morphine, meperidine (Demerol™), codeine, oxycodone, hydrocodone and propoxyphene. Many of these are found in combination with acetaminophen, such as (hydrocodone and acetaminophen) Vicodin™ and Tylenol with Codeine #3 ™. Narcotic analgesics are often used in cancer related pain and pain from post-operative procedures, such as hip replacement. Older people are often under treated for pain because of fear of addiction. However this risk is far lower in the elderly than in the average population. Common side effects of these drugs include excess drowsiness and sedation, constipation, itching, and upset stomach.

The timing of pain medications is important. For continuous pain, regularly scheduled doses should be given. An additional pain medicine may be given as needed for break-through pain. A dose should also be given prior to physical therapy or physical activity that may exacerbate pain. Pain relievers may be given at night to help with sleep. Plenty of water should be taken to prevent constipation. The patient should be on a bowel program utilizing stool softeners such as Colace™.