By Hallie Levine June 19, 2023 at 2:00 p.m. EDT(iStock)
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As we age, our aches and pains can become frequent. For example, 70 percent of people between ages 50 and 80 report joint pain, according to a 2022 University of Michigan poll on healthy aging.
In many cases, they reach for an over-the-counter drug such as ibuprofen (Advil and generic) or acetaminophen (Tylenol and generic), the study found. Less often, they ask a doctor about the risks of using these medications.
“This is problematic,” says Beth Wallace, a rheumatologist and co-author of the Michigan research. Long-term use of ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) can harm your stomach, and high doses of acetaminophen can damage your liver. And then there are the problems that can go with taking more potent pain drugs. Here’s a look at four common types of pain and how to safely treat them.
Headaches
Almost 20 percent of people older than 65 say they have headaches more than twice a month, according to a Mayo Clinic report. The most common are tension-type headaches (which cause pressure on both sides of the head) and migraines (which cause throbbing pain or a pulsing sensation on one side of the head).
Ease the pain: For occasional mild headaches, you can treat yourself with acetaminophen or an NSAID. But taking NSAIDs regularly to treat headaches could actually worsen the problem by triggering medication-overuse headaches, says Alan M. Rapoport, a professor of neurology at UCLA.
So if you experience headaches more than twice a month or they significantly interfere with your daily activities, Rapoport advises making a doctor’s appointment. It may be useful to try nondrug treatments, possibly with medication. For example, some research shows that acupuncture could help. And there’s even better evidence for biofeedback training, in which a therapist uses special tools to help headache sufferers manage their pain by controlling their heart rate, breathing and other functions.
In some cases, prescription drugs are appropriate. Triptans, such as sumatriptan, are often prescribed for migraines, although they should be taken with caution, especially by older people at increased risk of heart disease or a stroke, because they can elevate blood pressure.
For persistent, frequent tension headaches, doctors may prescribe small doses of amitriptyline or nortriptyline. Although these drugs are classified as antidepressants, they may also ease these headaches, Rapoport says.
Aching feet
Up to one-third of adults ages 65 and older regularly experience foot pain, according to a 2019 study in the journal Arthritis Care & Research.
One age-related factor may be osteoarthritis, a wearing away of cartilage, often between your foot joints, says Sean Peden, a foot and ankle orthopedic surgeon at Yale Medicine in Stamford, Conn. “Another big one is neuropathy, which is like arthritis for your nerves,” and can lead to feet that are sensitive, achy or numb, he says.
Many people also lose some of the cushioning on the bottom of their feet as they age. “This causes you to walk on the bones of your feet, rather than on fat padding, which causes pain,” Peden says.
Ease the pain: First, invest in the right footwear. “I recommend a shoe with a relatively hard sole that’s cushioned and soft in the middle, like Birkenstocks or sturdy sneakers,” Peden says.
Stretching is a good idea, too, he says, adding that muscles tighten with age, leading to sore foot muscles and tendons. He recommends calf and sitting hamstring stretches. “When these muscles are loose,” he says, “they put less stress on the foot.”
For foot osteoarthritis, try rubbing on an OTC anti-inflammatory cream like Voltaren. For tingling, numbness or weakness, physical therapy could help by stimulating nerves. And for pain caused by the loss of fat in the pads of your feet, consider using padded shoes or shoe inserts, or wearing cushioned socks.
Knee pain
Osteoarthritis is also a common cause of knee pain, although some people may be treating it incorrectly.
According to the Michigan poll, 26 percent of older adults with knee or other joint pain take supplements such as glucosamine and chondroitin. But research into these supplements suggests that they don’t help, Wallace says, and high doses may be harmful.
Increasingly, some people are also turning to marijuana or CBD. But Wallace says there’s not enough evidence yet for or against their use for knee pain.
Ease the pain: Exercise and weight loss, where appropriate, can ease the pain of knee osteoarthritis and prevent it from worsening, says Jesse Charnoff, a physiatrist at the Hospital for Special Surgery in New York. Low-impact exercises, such as walking, cycling, rowing and deep-water running, are also important to strengthen muscles around the knee.
Not sufficient? Acetaminophen can help, especially “if you take it every eight hours as recommended, rather than just waiting for pain to become unbearable,” Wallace says. Two other options: a topical NSAID such as Voltaren and, for significant pain, steroid injections.
There’s a treatment the American College of Rheumatology cautions against: injections of hyaluronic acid. The ACR hasn’t found sufficient evidence of benefit, and some studies suggest that they may be associated with harmful side effects.
Lower back pain
In a 2019 survey from the National Center of Health Statistics, more than 45 percent of people 65 and older said they had back pain in the previous three months.
Osteoarthritis is once again a common culprit, says Matthew Chong, a spine surgeon at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. Osteoarthritis can be painful on its own, but it can also cause spinal stenosis, a narrowing of the spine that puts pressure on the back nerves and spinal cord. Other triggers include muscle strains and compression fractures.
Ease the pain: For most lower back pain, careful use of NSAIDs and acetaminophen is an option, but it’s best to start with nondrug measures. These include staying as active as you can. If you have significant pain, you may need to rest your back for a day or so, but not for much longer. “Movement helps to relieve muscle spasms and prevents loss of muscle strength,” Chong says. Using a heating pad or wrap a couple of times a day could also help, he says.
If your doctor says your pain stems from compression fractures, treatment is usually rest, OTC pain relievers or back bracing.
Once your back pain has eased, activities that involve strengthening and stretching can help. These can include walking, swimming and biking, as well as low-impact aerobics, yoga and tai chi. Try them on your own for a few weeks, then, if needed, ask for a referral to physical therapy, Chong says.
Trigger-point injections, where a numbing medication is injected into your back, are sometimes used to provide relief before the benefits of physical therapy or other treatments kick in. Steroid injections can provide temporary relief as well.
Surgery should always be a last resort. “We tend to throw the kitchen sink of conservative treatments at patients first,” Chong says.
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