September 01, 2020

'Low and slow' on pain meds

For many older adults, chronic pain is an unfortunate part of daily life. Navigating treatment for that pain can be a difficult balancing act, given the risks of potentially harmful side effects with pain medications, especially opioids. Still, pain relievers — both nonprescription and prescription — can be an effective component of a plan to reduce pain and improve quality of life.

Mayo Clinic doctors advocate an approach to pain management that involves working closely with your health care team and, when prescription pain relievers are necessary, taking a "start low and go slow" approach. A commentary in the March 2020 issue of Mayo Clinic Proceedings suggests that people first use nondrug approaches to chronic pain, such as applying ice or heat, doing physical therapy, or utilizing integrative medicine techniques such as acupuncture. Related medical issues, such as depression and inadequate sleep, also should be addressed.

If pain relief is inadequate, work with your team to assess the risks and benefits of medication options. This may include acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs), drugs originally designed to treat depression or prevent seizures — many of which have pain-relieving benefits — or opioids.

Start out with low doses. Include frequent follow-ups with your health care team. Move to higher doses slowly, and only if pain-related function is not adequately improved and it's believed that a higher drug dose will lead to noticeable improvement with acceptable side effect risk. To minimize potential side effects and drug interaction risk, tell your health care team about any...