Addressing Pain Management for Older Adults and the Opioid Epidemic

The opioid epidemic in the United States has reached crisis levels, but many older adults who face opioid addiction go unnoticed. Addiction treatment resources are typically focused on young and middle-aged Americans who become addicted to opioids after receiving a prescription for pain management. Even a prescription pain management drug can cause addiction, and many addicts turn to heroin as a substitute when their prescription runs out. From back pain to debilitating chronic conditions, millions of older Americans who experience pain become addicted to opioids and are at risk of an overdose just like their younger counterparts.  

The Elderly and Drug Addiction

In 1999, the Veterans Administration led a campaign to treat pain as the "fifth vital sign." This change in the health care system led to a significant increase in the number of opioid overdoses and addictions. From children to elderly adults, no age group is left unaffected by this startling epidemic, and the problem is worsening. One psychiatric study found that one in five people over the age of 65 take painkillers several times per week. The rate of addiction among those patients with chronic pain is 18 percent.  

Chronic Pain Management

Nearly half of all adults over the age of 65 deal with chronic pain from conditions such as arthritis, fibromyalgia, and diabetes. While it is important to adequately treat the symptoms of these conditions, it is also important to avoid prescribing opioid drugs to patients who would be better served by less habit-forming treatments. A journal review found that short-term opioid treatment in patients who are older and do not have cancer is safer than long-term opioid treatment. The older a patient is, the less likely he or she is to become addicted. However, addiction is always a possibility with opioids and it should be carefully considered in each case. Restrictions on opioid prescribing behaviors by doctors may have an adverse effect on older patients who need them. Nearly 30 percent of Medicare Part D patients in 2015 had one or more opioid prescriptions. The primary issue for health care workers and lawmakers moving forward will be to balance the benefits of pain management with the risk of addiction.  

Alternative Treatment Options

While opioids can be a viable treatment option, they are actually less effective for older adults with chronic pain. Due to the slower metabolic rate of elderly adults, opioids cause more severe side effects such as vomiting, constipation and falls. Doctors should be conservative when prescribing painkillers to elderly patients since they are more sensitive to the negative effects of these drugs. Physical therapy is a helpful form of alternative treatment that addresses pain through exercises geared towards improving mobility and repairing damage to the tissues. Massage therapy is often used in conjunction with physical therapy to reduce pain and improve mobility. Tai chi, yoga, cognitive behavioral therapy, and meditation are all non-drug approaches to pain management that elderly patients and their doctors may find helpful. With the opioid epidemic looming as a national crisis, clear and actionable steps are necessary. Government groups have suggested limits on opiate prescriptions and refills to make it more difficult to access painkillers for illegitimate purposes. In order to address the full spectrum of opiate addiction, doctors and policymakers should expand efforts to focus on elderly adults who become addicted as well as the young and middle-aged. Moving beyond opioids, holistic treatment options may be the best way to help older adults manage their pain without forming an addiction.