Creating a new paradigm in pain care for the elderly

Health and Human Services Secretary Sylvia Burwell deserves much credit for directing attention to – and resources to combat – the nation’s growing prescription drug abuse problem. However, as we focus on the misuse of opioids in society, we must not overlook the health threats posed to our most rapidly growing population – the elderly.

At first glance, this health care conflict may seem difficult to reconcile. Older Americans suffer more pain than their younger counterparts. More than two-thirds of individuals over age 65 have multiple chronic health conditions, and one of the most common comorbidities is neck or lower back pain. It is estimated that 60 to 75 percent of the elderly have persistent pain, with that rate even higher in nursing homes and assisted living facilities.

{mosads}Here’s where the problem lies: Pain relief medications that may be safe and workable for the public at large can be the catalysts for significant health crises among our older citizens. A National Safety Council report early this year found that those over 65 who take opioid pain medicines are 68 percent more likely to be hospitalized than those who take over-the-counter remedies. They’re also 87 percent more likely to die. That’s because seniors taking prescription opioids have a much greater likelihood of suffering fractures from falling, having impairment issues, or experiencing gastrointestinal or respiratory issues as a result of these drugs.

As our elderly population increases – over 40 million and growing – we need to address this issue. It’s wrong to expect seniors to expect a retirement defined by pain and discomfort. At the same time, we cannot limit the recommended solutions for that pain to medications that carry an unacceptably high risk of death, illness or disability. Prescription drugs that may work well for some older patients are too dangerous for others.

When preparing for surgery or other hospital procedures many doctors have already been exploring alternative, non-opioid methods to prevent or alleviate pain for their patients. Instead of using conventional morphine IV drips, they are finding success with preoperative cocktails of analgesic medications or with local anesthetics or nerve blocks. Some have found that intravenous acetaminophens provide the same pain relief as opioids without the harmful side effects.

The White House Conference on Aging is taking place July 13. This is a topic that should be discussed at that event. With such a high proportion of the elderly encountering some level of pain on a daily basis, we need to explore ways in which these men and women can have lives of comfort and mobility without anguish, and without trading one health problem for another.

The practice of medicine evolves as our knowledge expands. We are becoming increasingly aware that conventional prescriptions for pain are not necessarily in the best interests of our older citizens who deal with numerous and serious health challenges or for the health system at large who bears the additional cost of such episodes. We also realize that the elderly population is not homogenous, and that what works well for one senior may be harmful for another. 
It’s time for a broad discussion throughout the healthcare community on expanding our options for treating pain in elderly patients. The White House Conference on Aging is a good place to start.

Thorpe is chairman of the Partnership to Fight Chronic Disease (PFCD) and a Robert W. Woodruff professor and chair of the Department of Health Policy & Management in the Rollins School of Public Health at Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality.