Whether it’s for an occasional headache or chronic arthritis, there will be times you may need to reach for pills for pain. But people respond in different ways to counter pain. For instance, over the counter (OTC) pain medications like ibuprofen (Motrin, Advil, and generic) are more likely to cause gastrointestinal bleeding or kidney damage. And for lingering discomfort, like a backache that lasts for months, there are few effective oral pain medications that are safe to take long-term. In addition, what’s appropriate may depend on one’s overall health, the cause of the pain, and whether there is an underlying medical condition like heart disease or kidney disease. So, below are answers to common questions that may help.
What’s the best for occasional headaches or muscle aches? As we age, the OTC medication acetaminophen (Tylenol and generic) is usually recommended as the first-line treatment for everyday pains like these. It’s thought to have less risk of side effects than non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin and generic) and naproxen (Aleve and generic). Those can cause gastrointestinal (GI) bleeding, and long-term use has been linked to heart attack, stroke, heart failure, and kidney problems. Too much acetaminophen, however, can lead to severe kidney damage, so take no more than the recommended doses. In general, this means that people ages 65 and older should take no more than 3,000 mg of acetaminophen in a day-and a maximum of 2,000 mg daily if they have liver disease.
What if acetaminophen doesn’t help enough? For most older people, when everyday pain like muscle aches doesn’t respond to acetaminophen, it’s often fine to take a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen for a short period of time. If you’re an older adult who doesn’t have severe liver disease, kidney disease, or heart failure, it’s usually okay if you limit it to a five-day course and check with your doctor beforehand. You’ll want to ask your doctor which NSAID is best for you and check in with him/her if you end up taking an NSAID for longer than a week, I often suggest ibuprofen to patients vs. naproxen (Aleve and generic). It’s shorter acting, which means it stays in your system for less time if there is a complication.
If you think you’ll need an NSAID for a few days, ask your doctor whether you should also take an OTC drug to protect you from ulcers or GI bleeding. Such medications include famotidine (Pepcid and generic) and omeprazole (Prilosec and generic).
Is it safe to use acetaminophen every day for osteoarthritis (OA)? (degenerative arthritis)?
If you regularly take acetaminophen more than twice a week, it’s best to talk with your doctor about whether you should limit your daily dose to 2,000 mg. Here’s why: A 2024 study published in the journal Arthritis Care & Research found that people ages 65 and older who used acetaminophen regularly for 20 years were more likely to develop conditions such as gastrointestinal bleeding, heart failure, high blood pressure, and chronic kidney disease. The higher the dose, the higher their risk. For OA pain, adding in a topical OTC anti-inflammatory may give you sufficient relief at the lower dose of acetaminophen. Topical use seems to work best on joints where there’s not a lot of underlying tissue, like your knees, hands, and wrists. (See more in “When to Try Topical Meds” below) You can apply a topical to the affected joint three to four times daily, for as long as you need the relief.
Is it safe to take acetaminophen plus an NSAID?
Alternating between the two medications is sometimes helpful. In general, those who need this for pain relief might try starting with acetaminophen, then layer on ibuprofen as needed. If you use this strategy, try taking a lower-than-recommended dose of ibuprofen, at least initially, to reduce the risk of side effects, and limit use of the two medications together to five to seven days.
If one takes low-dose aspirin for heart issues, what can be done about pain relief?
In this case acetaminophen is the safest option. When NSAIDs are used with aspirin, even short-term, they raise the risk of a gastrointestinal bleed or kidney disease. And because NSAIDs may also increase the likelihood of heart attack and stroke, they may negate the heart benefits you get from daily aspirin.
What’s safe and works for severe discomfort?
For an acute flare-up of severe pain, or after surgery, your doctor may suggest tramadol (Ultram and generic), a mild opioid. This prescription drug is often considered safer for older adults than some stronger prescription pain drugs. However, tramadol is considered addictive and has been linked to an increased risk of hip fracture and worsening confusion in older adults with dementia. In all cases, its use should be limited to only a few days. Another option is a short course of acetaminophen plus a low dose of an opioid such as codeine, but only under a doctor’s guidance, who, if that doesn’t work, might consider a stronger prescription pain reliever short-term.
WHEN TO TRY TOPICAL MEDICATIONS
For chronic discomfort, notably the joint aches that can come with osteoarthritis, the over-the-counter topical NSAID cream diclofenac (Voltaren and generic) is often the best first option. A review of 39 studies found that it significantly reduced pain in about 60 percent of people. And because topical NSAIDs—which can come in a cream, gel, or patch—are less likely to be absorbed by the liver or kidneys, they’re much safer than oral ones for older adults to use regularly. Some research suggests that NSAID-based topicals may also help with the acute pain of sprains and muscle strains.
There’s less evidence for other kinds of topicals, like those that contain lidocaine or capsaicin (the substance that makes chili peppers spicy). But, despite the absence of sound research, they may be worth a try.
ROLE OF PHYSICAL THERAPY (PT)
Research consistently shows that physical therapy helps provide relief and improve the quality of life for those living with muscle or joint aches. The goal is that once you strengthen and stretch certain muscles, your pain improves sufficiently to reduce the need for medications. In PT, one can also learn how to move in ways that are easier on the body and when to use heat to help relieve discomfort. If it hurts to pick something up off the floor, a PT can teach you ways to overcome that discomfort. Your doctor can likely recommend a local physical therapist, and, with a referral, it is usually covered by Medicare. After stopping with physical therapy, one needs to keep up with the exercises at home to maintain established gains.
Below is a link to access my books available for purchase (digital or print versions):
Website: https://radiantmortontavel.com/
To be placed on the mailing list for future blogs, contact: tavelmorton@gmail.com