You may have heard on the news about one of the most significant problems in America’s healthcare system: the opioid addiction crisis. You may think that this has nothing to do with you. However, the use of opioid medications to treat pain has to do with all of us, especially with the control or management of pain in older adults.

A health care provider may prescribe you an opioid to help reduce pain after having had major surgery or injury. Also, you may have an opioid if you suffer from severe pain, such as cancer. Often, most doctors prescribe them for chronic pain.

However, prescribed opioids are often completely safe when consuming for a short time. Nonetheless, opioid addiction and misuse are still potential risks for most people.

We will share 10 pain management guidelines that allow you to maintain an independent and active life.

What are opioids?

Opioids are drugs that are derived from opium and are used to reduce the pain signal that our brain perceives. They are effective as pain relievers; however, opioids can cause a person to feel euphoric, drowsy, mentally confused, disoriented, constipated, and breathe too slowly. As opioids can cause a state of euphoria, it is very important to follow the instructions of health professionals because excessive use of these can lead to addiction.

Opioids are no longer the cornerstone of pain management because of the countless deaths caused by overdoses. This does not mean that they are not useful to control pain, but that their use should be restricted to strictly necessary cases and professionals’ supervision.

What are opioid medications?

Although they are not all on this list, these are the names of the most common medications: codeine, hydrocodone (i.e., Hysingla, Zohydro ER), hydrocodone with acetaminophen (i.e., Vicodin, Norco, Lortab), morphine (i.e., Kadian, MS Contin), oxycodone (OxyContin, Oxaydo), oxycodone with acetaminophen (i.e., Percocet, Roxicet), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), fentanyl (i.e., Duragesic, Fentora, Abstral).

Some are more powerful than others. You may have heard of tramadol (Ultram), a synthetic opioid pain reliever that, while less potent than other opioids, also poses very serious risks.

Opioids in the elderly

It would be irresponsible of me to say that older adults should not take opioid medications. The professional management of these medications plays a very important role in treating acute and chronic pain, despite the effects they have on the central nervous system. Effects like:

      • Sedation, drowsiness, and sleep disturbance
      • Cognitive impairment, hallucinations, delusions, and nightmares
      • Hyperalgesia (increased sensitivity to pain)
      • Toxicity
      • Tolerance (need for higher doses to control pain)

The liver, kidneys, and nervous system of older adults are much more sensitive to medications. The Beers Criteria, a list published by the American Geriatrics Society (AGS), includes opioids as potentially inappropriate medications for the elderly, and they should be used with extreme caution, especially in people who:

      • Have a diagnosis of dementia or cognitive impairment
      • Have suffered falls or had fractures
      • Have suffered from delirium (meperidine, for example, can induce or worsen an episode of delirium)
      • Have epilepsy or chronic seizures (tramadol can cause seizures, apart from anxiety, dry mouth, and severe mood swings)
      • They take antidepressants, antipsychotics, or benzodiazepines (Valium, Serax, Xanax, Restoril, Ativan, Halcion, Librium, among others)

With the negative effects of opioid medications and the addiction epidemic they have created, personalized pain management is crucial. Dr. Jeanette S. Ross, chair of the Geriatrics, Gerontology & Palliative Medicine division and director of the Geriatric Medicine Fellowship at the University of Texas Health Science Center at San Antonio shared some pain management guidelines that I put for your consideration since administering opioid medications to our older adults can have negative consequences.

      1. The central goal of pain management is for the elderly to be able to remain independent and active.
      2. Being able to control pain enables increased activity, which, in turn, helps break the vicious cycle of inactivity due to pain.
      3. The main cause of the pain must be identified and controlled, or corrected. It is not about prescribing medication and increasing your dose to suppress pain.
      4. Pain and depression go hand in hand, and therefore both should be evaluated. Antidepressants are useful in pain management, and their use should not be seen as a person’s weakness.
      5. Learning relaxation techniques helps to control anxiety and achieve a state of rest to self-control pain. The balance between body, mind, and spirit plays an essential role in the treatment of pain.
      6. Non-drug therapies should be an integral part of treatment. For example, exercise, like aquatic aerobics, has no negative effects and contributes to the production of endorphins (hormones of happiness), which, in turn, act as natural pain relievers. Meditation, drawing, music, aromatherapy, and other non-drug therapies can be more effective than increasing the dose of opioid medication.
      7. Tramadol, like traditional opioid medications, should be used with caution. Its side effects include nausea, dizziness, drowsiness, tremors, confusion, and hallucinations.
      8. Opioid medications should never be shared or prescribed to others, and care should be taken to keep them out of the reach of adolescents.
      9. Pain medications should be taken when the first symptoms of pain appear. Waiting until the pain is severe before taking the medication does not contribute to the proper management of the drug regimen or the person’s ability to maintain a good activity level.
      10. Leftovers from any medication, but especially opioids, must be disposed of safely. Suppose you cannot dispose of these on National Prescription Drug Take-Back Day or dispose of them in designated containers at your pharmacy. In that case, you should mix them with substances like coffee grounds or kitty litter, put them in a plastic bag or airtight container, and dispose of them in the garbage. Fentanyl patches have instructions for flushing them down the toilet.

If you take care of a loved one, consider that the control or management of pain in our older adults, with and without opioid medications, can contribute to their well-being, independence, and a better quality of life.