Q: I live in chronic pain. I have severe osteoporosis, several "ruptured disks" in my back and have had hip surgery and several broken bones. Many pain medicines upset my stomach, what can I do to enjoy life again?
A: The disorders you mention can cause pain and can limit your ability to remain active and independent. Here are some suggestions you will want to discuss with your physician.
First, be sure to clearly identify the type of pain you are having. Pain from osteoporotic fractures is likely to be quite severe initially and later can become deep-seated and aching. Pain due to "ruptured discs" often represents irritated nerves and is usually described as a numb feeling. The correct pain medication will depend on the type of pain you are experiencing.
Second, look at the medication regimen you are on. Are you taking the medication on a regular basis or only when you need it? Since you have chronic pain, you will probably benefit from having some pain medication in your system at all times.
Next, think about the side effects of the pain medication you are using. Sometimes the side effects are worse than the pain itself! You mention stomach trouble due to the medications. Be sure to take the medications with food. Also discuss with your physician if you are eligible for some of the newer categories of pain medications designed to be gentler on the stomach.
Now, let's talk again about the type of pain you are having. If your pain is from arthritis or old osteoporotic fractures, the recommended painkiller to start with is acetaminiophen (Tylenol) in regularly scheduled doses up to four grams a day. If acetaminophen is not helpful, ibuprofen is often prescribed next. The use of ibuprofen by older adults can cause stomach irritation or problems for the kidneys, so you should discuss this with your physician first. There are new ibuprofen-like drugs available that have less stomach side effects. If these products fail to control pain, combination products such as acetaminophen with codeine are often needed. The side effects to be aware of include constipation and sedation. Finally, weight-bearing exercise, adequate calcium intake (1500mg/day) and Vitamin D (400IU/day), and for some women estrogen, are important for maintaining the bone strength you have.
If the pain you are experiencing is due to the ruptured discs, there are some medications that are useful in calming this type of pain. These drugs stop irritated nerves from firing pain signals to the brain. One such drug is Elavil (amitriptyline), formerly a widely used anti-depressant. In low doses, it can kill chronic pain. These are doses much lower than those used in the past for depression.
Believe it or not, some seizure medicines have also been found to control chronic pain even in people who don't have seizures.
Clearly it is difficult to live in chronic pain. Keep in mind however, how important it is to stay active. Exercise helps keep the body fit and can actually help limit chronic pain and disability, too. A healthy diet rich in fruits and vegetables is also important in keeping our bodies healthy. These healthy practices can even help prevent the constipation that some pain medications can cause.
We hope this list provides you with some ideas to take to your doctor.
Send your health-related questions to Aging Gracefully, c/o Center on Aging, University of Kansas Medical Center-Wescoe 5026, 3901 Rainbow Blvd., Kansas City, Kan. 66160-7117.