• Posted July 8, 2022

Aching Backs in Seniors: An Expert's Guide to Pain Meds

Back and neck pain are often an unfortunate part of aging, but older adults can safely find relief with various medications, a new research review concludes.

The review of 138 clinical trials breaks down the evidence on medication options for seniors with "spine-related" pain - essentially any aches along the neck and back.

An overarching point is, there is no one-size-fits-all remedy, according to senior researcher Dr. Michael Perloff, a neurologist at Boston University School of Medicine and Boston Medical Center.

Medication choices, he said, depend partly on the underlying cause of the pain. But particularly with older adults, any co-existing health conditions and medications they are taking are also a factor.

"You do have to be careful about medication interactions and side effects," Perloff said.

At the same time, those issues should not bar older adults from getting pain relief, he stressed.

"If you're an older person and you've been told there are no options for managing your pain, you may need to see a pain specialist," Perloff noted.

"There's a lot we can do with the weapons of medication, injections, physical therapy and, in some cases, surgery," he added.

With younger adults, back and neck aches are often muscle-related. While that can be true for older adults, too, Perloff said, they often have pain related to degenerative changes in the spine - such as wear-and-tear breakdown in the discs or cartilage cushioning the spinal joints.

For that type of pain, common painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, can help, the review found.

NSAIDs, like ibuprofen and naproxen (Motrin, Aleve), are more effective than acetaminophen (Tylenol), Perloff said. But acetaminophen may be the safer choice for some seniors, including those who are at increased risk of stomach bleeding, or who have kidney or heart disease.

With NSAIDs, limited use is key. Perloff's team recommends that older people take them for two or three days during a pain flare-up, but avoid using them for weeks at a time.

"With chronic pain, it's often up and down," Perloff noted. "So your treatment needs are different at different times."

In some cases, pain stems from a pinched nerve. One example is sciatica, where the sciatic nerve is compressed - often by a disc in the lower spine that slips out of place. That can cause pain that radiates from the lower back down the back of the leg.

NSAIDs can help ease sciatica, the review found. But another option, Perloff said, is medication specific to nerve pain - namely, gabapentin and pregabalin.

Those medications come with their own potential side effects, including dizziness and balance problems. So, the review found, any benefits have to be weighed against those risks, especially for older people who are taking other medications that can cause dizziness and falls, such as benzodiazepines.

Among the other findings:

• Certain muscle relaxants, like carisoprodol and chlorzoxazone, carry a risk of sedation and falls. But some others, including tizanidine and baclofen, can safely ease older adults' neck or back pain, in low doses.
• For chronic low back pain, some antidepressants - especially duloxetine (Cymbalta) - have proven helpful in trials. They may be good choices, Perloff said, when an older adult has both pain and depression symptoms.
• When oral drugs fail, injections of painkillers or anti-inflammatory corticosteroids may help with chronic pain.

The review, published recently in the journal Drugs & Aging, focused on medications. But Perloff said that when his patients have chronic pain - generally three months or more - he's probably also prescribing physical therapy.

"Physical therapy can be valuable for optimizing and maintaining function," agreed Dr. Robert Griffin, an anesthesiologist at the Hospital for Special Surgery in New York City who specializes in evaluating and treating back and neck issues.

Griffin, who reviewed the findings, also pointed to some other options. They include trigger point injections, where medication is injected into painful "knots" in the muscles; radiofrequency ablation, where radio-wave heat is applied to specific nerve tissue, to decrease pain signals from that area; and acupuncture and meditation, which may help ease symptoms or provide help in coping with them.

As for when people should see a health care provider for a painful back or neck, Griffin said "anytime they feel help is needed."

He stressed, though, that people should seek medical care right away if they have additional symptoms that could indicate a serious health condition. Those include limb weakness, changes in bladder or bowel function, fever or unexplained weight loss.

More information

The Hospital for Special Surgery has more on back and neck pain.

SOURCES: Michael Perloff, MD, PhD, assistant professor, neurology, Boston University School of Medicine and Boston Medical Center; Robert Griffin, MD, PhD, anesthesiologist, Hospital for Special Surgery, New York City; Drugs & Aging, June 27, 2022, online