Comprehensive Pain Management for Older Adults

This blog post distills the key lessons from a clinical training module on “Pain Management of the Older Adult.” It explains why pain is different in later life, how to recognize it (even when words are hard to find), and what treatments—non-drug and medication-based—can safely help. Most importantly, it walks you through what to do when pain shows up: at home, at the clinic, after a procedure, or during a flare.

Why Pain in Older Adults Requires a Different Playbook

Pain is the top reason people seek care. Among community-dwelling older adults, about half live with pain, which increases the risks of disability, falls, social isolation, depressed mood, sleep problems, and reduced quality of life. Pain is not just a symptom—when it persists beyond several months, it becomes its own disease process, with changes in the nervous system and emotion that amplify suffering and complicate treatment.

Aging also changes the body’s “pharmacology landscape.” Lean body mass and total body water decline while body fat increases; kidney clearance and some liver enzyme pathways can slow. Those shifts affect how medicines are distributed, metabolized, and eliminated—raising the stakes for careful dosing, monitoring, and drug selection. Practical translation: older adults are more vulnerable to medication side effects and interactions, so a “start low, go slow, and watch closely” mindset is essential.

How to Recognize Pain: Listen to Words—and Behaviors

Start with a simple pain story

Whenever possible, capture a brief pain narrative:

Onset and course: When did it start? Is it constant or intermittent?
Location and character: Sharp, dull, stabbing, burning, throbbing?
Intensity: Use 0–10 rating, a verbal scale (mild/moderate/severe), or a faces scale for those who prefer pictures.
Triggers and relievers: Movement, rest, heat/cold, certain activities?
Impact: What daily tasks or sleep are affected?

If answers seem inconsistent, reframe your questions with everyday comparisons (e.g., “Does it feel like a pinprick—sharp—or like a bruise—dull?”). Many older adults underreport pain due to stoicism or cultural beliefs; gentle, concrete language helps.

Watch for nonverbal clues

Some people—especially those with cognitive or communication challenges—signal pain through:

Facial grimacing, guarding, rubbing
Restlessness, pacing, withdrawal, aggression, agitation, tearfulness
Appetite changes, sleep disruption, gait changes

Validated tools exist for intact cognition (Numeric Rating Scale, Verbal Descriptor Scale, Faces Pain Scale, Visual Analog Scale) and for advanced dementia or limited communication (e.g., PAINAD, PACSLAC, Doloplus-2). The goal isn’t perfection; it’s consistency—pick tools your team can use reliably so changes can be tracked and acted upon.

Don’t forget mood, function, and quality of life

Pain and depression often travel together, each worsening the other. Quick screens like the Geriatric Depression Scale (short form) help you catch treatable mood contributors. For function, pair pain assessment with simple, repeatable checks:

Timed Up and Go (TUG) for mobility and fall risk
ADLs/IADLs (Katz, Lawton) for self-care and independence
Brief quality-of-life or pain interference scales (e.g., Brief Pain Inventory, Geriatric Pain Measure)

First Rule of Treatment: Find and Treat the Source

Before thinking about long-term management, rule out dangerous causes (e.g., cardiac, infection, fractures, progressive neurologic issues). If the pain is acute, treat the underlying injury or illness and use short-term relief strategies. If it’s chronic (>6 months or recurrent), plan for a program rather than a prescription: combine physical, psychological, social, and medication tools, and review the plan frequently.

A helpful way to organize actions is to separate them into:

Symptom control now: bring pain down, ease inflammation, improve sleep, lower anxiety.
Return to function: restore strength, mobility, confidence, and daily routines.
Long-term protection: reduce flare triggers, address mood, and build self-management habits.

Non-Drug Strategies That Truly Help

Tailor to the person. Beliefs and preferences matter—what someone enjoys and believes in is more likely to be used consistently. Mix and match:

Physical modalities:
Heat or cold packs, TENS units, gentle ultrasound, and massage can reduce pain and stiffness with minimal risk. Many older adults love the immediate comfort of warm packs for arthritic joints.
Movement therapy:
Physical therapy (stretching, strengthening, posture, balance) and low-impact exercise (walking, swimming, cycling) decrease pain over time and reduce fall risk. Occupational therapy teaches pacing, joint protection, safer techniques for bathing, dressing, cooking, or lifting.
Mind–body and psychological supports:
Relaxation breathing, guided imagery, progressive muscle relaxation, and biofeedback can quiet pain pathways and lower anxiety. Brief cognitive-behavioral strategies improve coping and reduce catastrophizing. For many older adults (and families), group or couples counseling lowers interpersonal stress that magnifies pain.
Complementary options:
Acupuncture can help in both acute and chronic conditions for some people. Herbal supplements may be beneficial but must be checked against current medications to avoid interactions—enlist a pharmacist on the care team.

Medication Strategies: Start Low, Go Slow, Check Often

Medications can be powerful allies, especially when non-drug measures don’t go far enough. But with older adults, caution is key—aging kidneys, livers, and brains are less forgiving.

Over-the-counter and non-opioid options

Acetaminophen (paracetamol): Useful for many kinds of musculoskeletal pain. Mind total daily dose and liver health.
NSAIDs (e.g., ibuprofen, naproxen): Can help with inflammatory pain but carry GI (ulcer/bleeding), kidney, and cardiovascular risks. Use with food; consider stomach protection (e.g., a proton pump inhibitor) in high-risk patients; avoid or limit in kidney disease, heart failure, or high vascular risk. Monitor closely.

Opioids: reserved, structured, and monitored

When pain is moderate to severe and other options fall short, opioids may be considered with clear goals, safety checks, and frequent reviews. Match drug and formulation to the pattern:

Short-acting (2–4 hours) for intermittent or breakthrough pain.
Long-acting (≈12 hours or patches) for persistent daily pain—with a small, planned dose for breakthrough episodes.

Expect and proactively treat side effects (nausea, constipation, sedation, confusion, itching). Reassess function, risks (falls, delirium), and effectiveness often. Some practices use opioid agreements (one prescriber, one pharmacy, occasional pill counts/urine tests) to keep everyone safe and aligned.

Adjuvant analgesics

For nerve-driven or centralized pain, adjuvants can be very helpful:

Antidepressants (e.g., duloxetine; select tricyclics with caution) may reduce neuropathic pain and improve sleep.
Anti-seizure agents (e.g., gabapentin, pregabalin, carbamazepine) are commonly used for shooting/burning pain.
Muscle relaxants (e.g., cyclobenzaprine, baclofen) may help spasms but can cause sedation and confusion—use sparingly.
Topicals (menthol/camphor rubs, topical NSAIDs, lidocaine patches) provide localized relief with fewer systemic effects, though they may be trickier to apply.

Always consider the “CNS burden.” In older adults, stacking sedating drugs (opioids + muscle relaxant + benzodiazepine) can tip someone into falls, confusion, or hospitalization. Streamline regimens where possible.

A special note on dry mouth (xerostomia)

Many pain medications reduce saliva, leading to trouble with chewing, dentures, taste changes, and dental caries. Tactics: frequent sips of water, sugarless gum/candies, saliva substitutes, and prescription fluoride toothpaste; coordinate with dental and speech therapy as needed.

Build a Person-Centered Care Plan

Great pain care is team care anchored to what matters to the person:

Shared goals: What daily activities does the person want back first (e.g., walking to the mailbox, cooking dinner, attending church)?
Education: Explain what’s hurting, why it hurts, what each tool does, and how long it should take to see benefit. This demystifies care and boosts adherence.
Mental health integration: Screening and treatment for depression/anxiety can meaningfully lower pain intensity and improve sleep.
Community resources: Exercise classes, chronic disease self-management workshops, caregiver groups, and nutrition programs sustain gains between clinic visits.

Prevention and Flare Control: Make a Written Plan

Because pain fluctuates, create a simple Pain Action Plan that the person, family, and caregivers can follow:

Daily habits to protect joints and nerves
- Consistent sleep schedule; avoid long daytime naps.
- Regular movement (even short, frequent walks and light stretches).
- Balanced nutrition to support tissue repair and medication tolerance.
- Quit smoking (nicotine worsens pain perception and reduces blood flow).
- Moderate alcohol to avoid drug interactions and depressed mood.
Pre-empt painful activities
- Medicate before activity when advised (e.g., 30 minutes prior to physical therapy or bathing).
- Use heat to loosen stiff joints before movement and ice after exertion if inflammation flares.
When pain rises
- Follow the plan: apply heat/cold, use prescribed short-acting medicine, practice breathing or relaxation, and do gentle movement rather than full bedrest.
- If pain predicts a known trigger (e.g., long car rides), plan breaks and supports (lumbar pillow, ankle pumps).
When to call for help
- New, severe, or unusual pain (especially chest pain, sudden weakness/numbness, high fever, severe abdominal pain).
- Side effects: confusion, excessive sleepiness, falls, vomiting, black stools, reduced urination, allergic reactions.
- Pain that stays high despite the action plan, or pain that is increasing week to week.

How Readers Can Address Pain When It Arises: A Quick Checklist

For older adults and families

Keep a pain diary (0–10 score, location, what helped/hurt) for 1–2 weeks before appointments.
Bring all medicines and supplements (or a complete list) to every visit.
Ask your clinician which assessment scale you’ll use at home and in clinic—use the same one consistently.
Build a home toolkit: hot/cold packs, TENS (if recommended), a timer for activity pacing, comfy shoes, and a printed relaxation script.
Post your Pain Action Plan on the fridge: daily habits, pre-activity steps, flare steps, and red-flag symptoms with phone numbers.

For caregivers

Learn the person’s nonverbal pain signs and track them.
Help implement pacing (break tasks into smaller steps, rest between).
Encourage gentle movement even on tough days (a little is better than none).
Watch for side effects and hydration; many issues are preventable with earlier calls and small adjustments.

For clinicians and care teams

Use a standardized intake that includes pain intensity, function (TUG/ADLs), mood (GDS), and sleep.
Start with non-drug therapies, add lowest-risk meds as needed, and review every change within days to weeks (not months).
Minimize polypharmacy and rationalize the regimen (fewest drugs, fewest doses that work).
Engage pharmacy, PT/OT, mental health, dentistry, and social services early—true multimodal care wins.

Final Thoughts

Managing pain in later life is not about chasing a “zero” on the pain scale. It’s about making life bigger as pain gets smaller—restoring sleep, walking a little farther, cooking a favorite meal, and reconnecting with friends. That requires three things: careful listening, consistent measurement, and layered treatments that respect the aging body. When you combine practical non-drug measures with thoughtful, monitored medications—and anchor everything to the older adult’s priorities—you get safer care, better function, and more good days.

If pain is affecting you or someone you care for, use the checklists above to prepare for your next visit, ask your clinician to help you build a written Pain Action Plan, and schedule a follow-up to see what’s working and what needs to change. Momentum matters; small, steady improvements add up.

This article summarizes key points from a geriatric pain management training module and is for education only. Always consult your healthcare provider for personalized advice and medication decisions.

Source:
Based on “Pain Management of the Older Adult – One Slide per Page” training document.

Disclaimer:
This blog post summarizes educational material for informational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Readers should always consult their healthcare provider before making changes to pain management plans, medications, or therapies. Clare Senior Care AFC | GAFC and the author are not responsible for outcomes resulting from independent application of this information.

Daily Living Tips, Senior Education

Pain Management for Older Adults: A Friendly, Practical Guide for Families and Care Teams