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Spring 2025
Spring 2025 Issue Therapy: Managing Chronic Pain Considering Nonpharmacological and Pharmacological Approaches As the average lifespan of people increases each year, managing chronic pain in elderly patients is becoming a more critical health care challenge. Chronic pain, often stemming from conditions such as arthritis, neuropathy, and other age-related ailments, requires a careful approach that balances effective relief with minimal side effects. This is where pharmacological and nonpharmacological strategies come into play as both have vital roles in creating comprehensive pain management plans. Pharmacological treatments, including analgesics and anti-inflammatory medications, can provide necessary relief but may carry risks of adverse effects, particularly in older adults with multiple health concerns. Conversely, nonpharmacological approaches such as physical therapy, acupuncture, cognitive behavioral therapy, and lifestyle modifications offer promising alternatives or complementary options to traditional medications. This article will explore the effectiveness of these strategies as well as discuss other up-and-coming practices and challenges that patients may face when adapting to a proposed care plan. Nonpharmacological He cites programs like tai chi and yoga, which are gentle on the body and improve balance and overall well-being, as helping older adults deal with pain. “Then there’s heat and cold therapy—simple, effective, and easily accessible for targeting localized pain,” Lyons says. “These methods work well for elderly patients because they’re generally low risk, avoid the complications of polypharmacy, and empower patients to take an active role in their care.” In addition, Kevin Cooke, MD, a primary care physician with Aviv Clinics in The Villages in Florida, shares that in his experience, physical therapy and gentle exercise programs have been highly effective for managing chronic pain in elderly patients because they enhance mobility and reduce pain without the risks associated with medications. “Holistic medical interventions like the Aviv Medical Program, which brings all of these modalities together with hyperbaric oxygen therapy, as well as other things like mindfulness meditation and acupuncture, have proven beneficial by addressing both the physical and psychological aspects of pain,” he says. Pamela Walters, DO, medical director and consultant psychiatrist at Eulas, has extensive experience in innovative treatments for mental health and chronic pain management. She notes nonpharmacological treatments can include physical therapy, acupuncture, mindfulness sessions, and lifestyle changes. “The key advantages are fewer side effects and long-term functional improvements,” she says. “However, they often require consistency and patience before results are seen, which can be difficult for seniors with mobility or cognitive challenges.” Pharmacological “The advantage is that these can provide more immediate relief, but they also come with risks, particularly in older adults, so thorough evaluation by a medical professional is required before recommending these types of treatment options,” Walters says. Other pros of these treatments include quick and effective pain relief, which can significantly enhance daily functioning for seniors. “Various medications, such as NSAIDs, opioids, and nerve pain medications, can be tailored to individual needs, allowing for targeted pain management,” says Tanner Gish, a certified dementia practitioner and director of operations at Loving Homecare Inc. “The accessibility and widespread prescription of these drugs make them a convenient option for many older adults.” However, experts caution that these pharmacological solutions come with notable drawbacks. Seniors face an increased risk of side effects, including drowsiness, dizziness, and gastrointestinal issues. There is also a heightened chance of dependency, especially concerning opioid medications. “Additionally, potential interactions with other medications can pose further risks, necessitating careful management,” Gish says. In Combination Combination approaches can be highly effective, as there’s often quick relief of medications whilst also promoting long-term resilience through psychological and physical therapies. This approach requires personalized treatment plans, which may not always be accessible. Pros of combination treatments include a balanced approach to pain management. Medications can provide immediate relief, while nondrug therapies—such as physical therapy, acupuncture, or cognitive behavioral therapy—support long-term management of pain. This dual strategy can reduce reliance on high-dose medications, thereby minimizing risks and side effects associated with excessive drug use. Furthermore, combination treatments address both the physical and psychological aspects of chronic pain, promoting overall well-being and improved quality of life. However, Gish warns, this approach is not without its cons. Implementing combination treatments requires highly personalized plans that may involve considerable trial and error to find the most effective regimen. Additionally, coordinating care among multiple health care providers can pose challenges, particularly for older adults managing several specialists. Ongoing costs and a commitment to nondrug therapies can also be demanding, as they often require continuous engagement over the long term. Barbara Sparacino, MD, FAPA, a geriatric psychiatrist and caregiver advocate, notes that managing chronic pain in elderly patients requires a careful, compassionate balance between nonpharmacological and pharmacological approaches. “I’ve seen how addressing pain holistically can significantly improve the quality of life for aging adults,” she says. “Nonpharmacological strategies are my go-to starting point. Gentle exercise, like yoga or water aerobics, can strengthen muscles and improve mobility, which often reduces pain. For more passive options, heat and cold therapy, acupuncture, and even relaxation techniques like guided imagery or mindfulness meditation can be incredibly effective.” On the pharmacological side, Sparacino advocates for a cautious, individualized approach. “Start low and go slow is the rule with older adults due to potential interactions and sensitivities,” she says. “Over-the-counter options like acetaminophen are often effective for mild pain, while prescription medications like low-dose antidepressants or gabapentin may help with nerve pain. Opioids are typically a last resort and only under strict management to avoid dependency or side effects.” Additional Strategies to Consider Moti Gamburd, CEO of CARE Homecare, who has helped older adults manage chronic pain for over a decade, notes one area that doesn’t get enough attention is guided relaxation. There are simple tools like apps, online videos, and local meditation classes that can be used. “Pain and stress feed each other; if one is anxious about one’s pain, it will often make it hurt more,” he says. “Guided relaxation techniques, such as progressive muscle relaxation, instruct one’s body to let go of the tension that increases pain. On the other hand, mindfulness offers something else to concentrate on other than the discomfort and teaches people to approach their pain with greater calm and control.” For example, Gamburd worked with a woman who fought against chronic back pain for many years. While medications and physical therapy helped to an extent, none really addressed the emotional weight of her pain. “We introduced her to a senior-friendly meditation group, and this was a turning point,” he says. “She learned how to use mindfulness during painful moments and, instead of feeling defeated, was empowered. It wasn’t about reducing pain as much as it was giving her some of her life back.” Mind-body interventions are nothing new. Research has shown that mind-body interventions like mindfulness and cognitive behavioral therapy can significantly reduce chronic pain and improve quality of life in older adults by enhancing pain-coping strategies and reducing stress. These approaches are supported by multiple studies demonstrating their effectiveness in pain management. Cannabis and Botanicals “Many pharmaceuticals have side effects that can be exacerbated in the senior population,” she says. “The elderly are more prone to side effects such as dizziness, drowsiness, difficulty concentrating, and impairment in judgment and motor coordination. Cannabis, when dosed correctly, can often avoid those same side effects. The endocannabinoid system, like many other systems in our body, often sustains damage as we age, making the phytocannabinoids in cannabis an effective option for supplementing the decline in endocannabinoid production.” Common Challenges “There is limited insurance coverage for therapies like physical therapy or counseling,” Lyons says. “Transportation is another issue. Patients may have difficulty traveling to appointments, especially for those with mobility issues.” Then there’s the stigma of it all, with some patients reluctant to seek mental health support, believing that pain is just a part of the aging process. “Health care providers can address these by offering telemedicine for counseling, follow-ups, and therapy sessions,” Lyons says. “They can also refer patients to community programs for transportation or financial support.” Formulating a Plan Lyons notes a thorough assessment starts with a pain history and functionality assessment, understanding the type, location, and severity of pain and its impact on daily activities. “You should always ask patients what outcomes they value most, such as improving mobility or sleeping better,” he says. “You also need to consider personal beliefs, support systems, and potential barriers to treatment.” Keep in mind that pain is dynamic, so care plans must adapt over time. “By centering the patient in these conversations, we create a collaborative and effective plan that respects their unique situation,” Lyons says. “Chronic pain management for elderly patients isn’t just about alleviating symptoms, it’s about improving their quality of life and maintaining their independence,” Lyons says. “By combining innovative strategies with compassionate care, we can help patients live fuller, more comfortable lives.” — Keith Loria is a freelance writer based in Oakton, Virginia. |
