Nearly One in Five Seniors Takes
Medication for Chronic Pain

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

The following information is reproduced with the permission of
The National Council on the Aging.

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Nearly One in Five Seniors Takes Medication for Chronic Pain

-- Low Awareness of Side Effects Places Many Older Americans at Unnecessary Risk --


Nearly one in five Americans over age 60 regularly takes medication for chronic pain, according to a 1997 survey conducted for The National Council on the Aging (NCOA) by Louis Harris & Associates. The majority of the 7.5 million seniors who take medication for chronic pain say their medications are effective, but one in four suffers from side effects caused by the drugs. Nearly 40 percent say doctors don't discuss possible side effects of pain medication they prescribe, and half say doctors don't warn them about potential drug interactions.

Low awareness of the side effects of pain medication places seniors at unnecessary risk, according to James P. Firman, Ed.D., NCOA president and CEO. "Most pain can be managed successfully with medication," Dr. Firman said. "But as people age, they are more susceptible to serious drug side effects and to dangerous interactions between their pain drug and other medications they take. It's critical for seniors to understand these risks and to ask their doctors for the safest alternatives."

The survey found that older people are more likely to suffer from arthritis, other bone and joint pain, and low back pain than other types of pain conditions. For these conditions, seniors are more likely to take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, than any other types of prescription medication, followed respectively by propoxyphenes and codeine derivatives, such as hydrocodone. While NSAIDs are less potent than propoxyphenes and codeine derivatives, they carry higher risk for serious gastrointestinal side effects in older patients. One in four seniors who takes prescription NSAIDs experiences side effects; of these, 13 percent have ulcers. These findings are consistent with clinical studies that show ulcers and other serious gastrointestinal side effects caused by NSAIDs are the leading adverse drug reactions in the United States.

"The serious side effects caused by NSAIDs result in 200,000 hospitalizations and 20,000 deaths annually," said Thomas J. Schnitzer, MD., Ph.D., Northwestern University Medical School, Chicago, a rheumatologist and geriatrician who participated in a recent conference called by the National Institutes of Health to study safety issues surrounding NSAIDs. "The treatment cost for NSAID-induced side effects is $3 billion a year," he said. "Older patients are at higher risk for these complications."

Dr. Schnitzer is concerned about the finding that older Americans typically take prescription NSAIDs for long periods of time. The majority take NSAIDs for six months or more despite warnings that risk for serious gastrointestinal complications increases four-fold after six months of use. Seniors are also likely to take over-the-counter pain NSAIDs far longer. On average, those surveyed take non-prescription NSAIDs daily for five years despite product labeling that cautions against more than 10 days of consecutive use.

Besides NSAIDs, propoxyphenes and other types of pain medication can also cause side effects, with drowsiness and dizziness the most common side effects reported by survey respondents. "Drowsiness and dizziness pose special risk for older people by increasing the likelihood they will fall," said Kathleen Cameron, RPh and M.P.H., a pharmacist and health educator for NCOA.

The survey found that in addition to pain drugs, more than half of seniors regularly take medication for disorders not related to pain, notably high blood pressure. "Because seniors typically take up to seven medications a day, they are at higher risk for drug interactions," said Ms. Cameron. A large number of seniors also take anti-ulcer drugs or antacids to manage side effects of their pain drugs, which could mask the warning signs of serious complications.

Side effects from medication may be one reason why two-thirds of seniors who take pain drugs say pain still interferes with their lives. "Living with pain is not an inevitable consequence of aging," Dr. Firman said. "Nor is living with serious pain drug side effects. It's important for seniors to take advantage of effective pain therapy, but only if they understand the risks."

For more information about pain management for older people, call 1-800-292-3513 (National Council on the Aging).

The Pain & Older Americans Survey is a survey of a national cross-section of 500 randomly selected Americans over age 60 who regularly take pain medication that was prescribed or recommended by their doctor for pain conditions lasting six months or longer. It was underwritten by an educational grant from Ortho-McNeil Pharmaceutical.

-- see also Pain Is Undertreated in Seniors, Experts Say

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