Q: My 88-year old mother often complains of various aches and pains. What is the safest over-the-counter painkiller for her to take? Aren’t some of them bad for your liver and kidneys?
A: Frequent aches and pains are a common problem for older adults.
If your mother has been complaining, you’ll want to make sure she gets a careful evaluation from her doctor. After all, frequent pain can be a sign of an important underlying health problem that needs attention. You’re also more likely to help your mom reduce her pain if you can help her doctors identify the underlying causes of her pain.
That said, it’s a good idea to ask what over-the-counter (OTC) pain relievers are safest for older people.
That’s because improper use of OTC painkiller tablets is actually a major cause of harm to older adults.
So let me tell you what OTC pain relievers geriatricians usually consider the safest, and which very common group of painkillers can cause serious side-effects in aging adults.
What’s the safest OTC painkiller for an aging parent?
For most older adults, the safest oral OTC painkiller for daily or frequent use is acetaminophen (brand name Tylenol), provided you are careful to not exceed a total dose of 3,000mg per day.
Acetaminophen is usually called paracetamol outside the U.S.
It is processed by the liver and in high doses can cause serious — sometimes even life-threatening — liver injury. So if an older person has a history of alcohol abuse or chronic liver disease, then an even lower daily limit will be needed, and I would strongly advise you to talk to a doctor about what daily limit might be suitable.
The tricky thing with acetaminophen is that it’s actually included in lots of different over-the-counter medications (e.g. Nyquil, Theraflu) and prescription medications (e.g. Percocet). So people can easily end up taking more daily acetaminophen than they realize. This can indeed be dangerous; research suggests that 40% of acetaminophen overdose cases are accidental.
But when taken at recommended doses, acetaminophen has surprisingly few serious side effects and rarely harms older adults. Unlike non-steroidal anti-inflammatory drugs (NSAIDs, see below), it does not put older adults at risk of internal bleeding, and it seems to have minimal impacts on kidney function and cardiovascular risk.
Be careful or avoid this common class of painkillers
At the drugstore, the most common alternatives to acetaminophen are painkiller tablets such as ibuprofen (brand names Advil and Motrin) and naproxen (brand names Aleve, Naprosyn, and Anaprox).
Both of these are part of a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). Many people are familiar with these medications. But in fact, older adults should be very careful before using NSAIDs often or regularly.
Unlike acetaminophen, which usually doesn’t become much riskier as people get older, NSAIDs cause side effects that are especially likely to become dangerous as people get older. These include:
- Increased risk of bleeding in the stomach, small bowel, or colon. Seniors who take a daily aspirin or a blood thinner are at especially high risk.
- Problems with the stomach lining, which can cause stomach pain or even peptic ulcer disease.
- Decreased kidney function. This can be especially problematic for those many older adults who have already experienced a chronic decline in kidney function.
- Interference with high blood pressure medications.
- Fluid retention and increased risk of heart failure.
Experts have estimated that NSAIDs cause 41,00 hospitalizations and 3,300 deaths among older adults every year.
Recent research has also suggested that NSAIDs cause a small but real increase in the risk of cardiovascular events (e.g. heart attacks and strokes).
Because of these well-known serious side effects of NSAIDs in older adults, in 2009 the American Geriatrics Society recommended that older adults avoid using NSAIDS for the treatment of chronic persistent pain. Today, oral NSAIDs remain on the Beer’s List of medications that older adults should avoid or use with caution. (For more on the Beer’s list, see this article: Medications Older Adults Should Avoid or Use with Caution: The American Geriatrics Society Beers Criteria 2019 Update.)
Now, it’s important to know NSAIDs can also be prescribed as creams or gels. These topical forms are much safer, and can be effective for pain relief.
Despite this fact, NSAID painkiller tablets are often bought by seniors at the drugstore. Perhaps even worse, NSAIDs are often prescribed to older adults by physicians, because the anti-inflammatory effect can provide relief from arthritis pain, gout, and other common health ailments.
(Commonly prescribed NSAIDs include indomethacin, diclofenac, sulindac, meloxicam, and celecoxib. These tend to be stronger than the NSAIDs available without a prescription. However, stronger NSAIDs are associated with higher risks of serious side effects, unless they are used as a cream or gel, in which case the risks are much less.)
Now let me share a true story. Many years ago, a man in his 70s transferred to my patient panel. He had been taking a daily NSAID for several months, prescribed by the previous doctor, to treat his chronic shoulder arthritis.
I cautioned him about continuing this medication, explaining that it could cause serious internal bleeding. He seemed dubious, and said his previous doctor had never mentioned bleeding. He wanted to continue it. I decided to let it slide for the time being.
A few weeks later, he was hospitalized for internal bleeding from his stomach. Naturally, I felt terrible about it.
This is not to say that older adults should never use NSAIDs. They are often more effective pain relievers than acetaminophen, especially for conditions such as arthritis. So even in geriatrics, we sometimes conclude that the likely benefits seem to outweigh the likely risks.
But this conclusion really should be reached in partnership with the patient and family; only they can tell us how much that pain relief means to them, and how concerned they are about the risk of bleeding and other dangerous side effects. (It’s also possible to reduce the risk of bleeding by having a patient take a medication to reduce stomach acid.)
Unfortunately, far too many older adults are never informed of the risks associated with NSAIDs. And in the drugstore, they sometimes choose ibuprofen over acetaminophen, because they’ve heard that Tylenol can cause liver failure.
Yes, acetaminophen has risks as well. But every year, NSAIDs cause far more hospitalizations among older adults than acetaminophen does.
Aspirin: a special NSAID we no longer use for pain
Aspirin is another analgesic available over-the-counter.
It’s technically also an NSAID, but its chemical structure is a bit different from the other NSAIDs. This is what allows it to be effective in reducing strokes and heart attacks. It is also less likely to affect the kidneys than other NSAIDs are.
(For more on the risks and benefits of aspirin, see this MayoClinic.com article.)
Aspirin is no longer used as an analgesic by the medical community. But many older adults still reach for aspirin to treat their aches and pains, because they are used to thinking of it as a painkiller. Aspirin is also included in certain over-the-counter medications, such as Excedrin.
Taking a very occasional aspirin for a headache or other pain is not terribly risky for most aging adults. But using aspirin more often increases the risk of internal bleeding. So, I discourage my older patients from using aspirin for pain.
Tips on safer use of OTC painkillers
In short, the safest oral OTC painkiller for older adults is usually acetaminophen, provided you don’t exceed 3,000 mg per day.
If you have any concerns about liver function or alcohol use, plan to use the medication daily on an ongoing basis, or otherwise want to err on the safer side, try to not exceed 2,000 mg per day, and seek medical input as soon as possible.
You should also be sure to bring up any chronic pain with your parent’s doctor. It’s important to get help identifying the underlying causes of the pain. The doctor can then help you develop a plan to manage the pain.
And don’t forget to ask about non-drug treatments for pain; they are often safer for older adults, but busy doctors may not bring them up unless you ask. For example, chronic pain self-management programs can be very helpful to some people. Physical therapy, massage, and certain forms of exercise can play an important role in pain relief, especially when it comes to chronic pain.
Now if your older parent is taking acetaminophen often or every day, you’ll want to be sure you’ve accounted for all acetaminophen she might be taking. Remember, acetaminophen is often included in medications for cough and cold, and in prescription painkillers. So you need to look at the ingredients list for all medications of this type. Experts believe that half of acetaminophen overdoses are unintentional, and result from people either making mistakes with their doses or not realizing they are taking other medications containing acetaminophen.
Last but not least: be sure to avoid the “PM” version of any OTC painkiller. The “PM” part means a mild sedative has been included, and such drugs — usually diphenhydramine, which is the main ingredient in Benadryl — are anticholinergic and known to be bad for brain health. (See 7 Common Brain-Toxic Drugs Older Adults Should Use With Caution for more about the risks of anticholinergic drugs.)
My own approach, when I do house calls, is to check the older person’s medicine cabinet. If I find any NSAIDs or over-the-counter anticholinergic medications (e.g. antihistamines, sleep aids, etc), I discuss them with my older patient and usually remove them from the house unless there’s a good reason to leave them.
If acetaminophen isn’t providing enough pain relief
If acetaminophen doesn’t provide enough relief for your mom’s pains, then it may be reasonable to consider over-the-counter (or sometimes prescription) NSAIDs, preferably for a limited period of time. But be sure to discuss the risks and alternatives with the doctor first, and be sure to discuss possible non-drug approaches to lessen pain.
You may also want to ask about topical painkillers, such as gels, creams, and patches. These are generally safer than oral medications, because less of the body is exposed to side effects.
For severe pain, it may also be reasonable to discuss other prescription drug options. Depending on the type of pain, in some cases it can be reasonable to consider using very small doses of opioids, or other types of painkillers. That said, bear in mind that all prescription pain relievers come with risks and can cause serious side effects. In older adults, most will affect brain function and balance.
The truth is that it’s often not possible to treat pain effectively and 100% safely, when it comes to using oral painkiller tablets. But by being informed and proactive, your family can help your mom get better care for her pain, while minimizing the risk of harm from pain relievers.
Good luck!
This article was reviewed & updated in March 2023.
[As we are approaching 200 comments, comments have been closed.]
Thanks for your articles…..they are definitely helpful, as was this one. But an article on pain relief meds that barely mentions narcotics? I recently had a biopsy that was really painful the next day. I happened to have some leftover oxycontin and took one (only one). That got me through the night, and the next day the pain was tolerable.
Pain medication is a big topic so it’s really not possible to address all types in a single article. This one focuses on over-the-counter analgesics.
Thank you for commenting and for your interest in the site.
Hi,
I have serious heath and pain issues!
In the last 3 years…severed Achilles’ tendon,reverse shoulder replacement, pulmonary embolisms due to a gene defect-PAi-1, c-diff colitis, pneumonia,strangulated intestines,severed rotator cuff-all 4 in the other shoulder, severe osteoarthritis in the knees, spinal stenosis.
I take hydocodone, tzanidine, naproxen sodium and acetaminophen for pain relief.
Ambien and trazadone to -sleep.
Xarelto for the PE’s, Paxil for OCD and lovastin for cholesterol and diovan for blood pressure.
I have listed all medication and I would like to find a replacement for naproxen sodium that is compatible!
Thanks,
Mike K.
Well, you don’t say how old you are, but it sounds like your health situation is quite complicated. As you are taking a blood thinner, that would increase your risk of bleeding from an NSAID and so it probably does make sense for you to try to find an alternative to using naproxen.
You will have to work with your own health providers to try to identify alternatives. I would especially recommend looking into non-pharmacological approaches to managing chronic pain. Exercise, cognitive therapies, mindfulness practices, and other lifestyle approaches can make a big difference and can enable people to reduce their use of pain medication, although they do require time and effort to implement. For some people, changing their diet and nutrition also helps.
Here is a proven program, you could see if it’s available in your area:
Chronic Pain Self-Management Program
There has also been increasing interest in cannabis as an option for managing pain. Research suggests it can be effective in some circumstances, however the short and long-term risks are not yet well understood (especially when it comes to older adults).
The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report
Generally, it is better and safer to minimize the use of medication and pharmacological substances. Good luck!
If you’d like find out about the long term effects of cannabis then come visit me in Alaska, where I have a couple of friends (62 and 66 yrs old) who have been using it since the early ‘70s. I am 63 and have been using cannabis for about 3.5 years and can say it is very effective in relieving pain, swelling, RLS, helps me sleep!
For geriatricians, the “long-term effects” means how does it affect a person who takes it for years when they are in their 80s, or 90s? We also don’t yet know how taking it for decades during one’s middle years will affect one’s later experience. Or, for that matter, how starting to use cannabis for pain at age 60 will affect one’s brain (and the rest of the body) when one is 75, 80, 85, or 90.
I expect we will eventually have the research data we need to understand this better, but it’s likely to take years.
It’s interesting that you reference dosage for Tylenol but say nothing about dosage levels for NSAIDs and their relation to studies done and findings. I seriously doubt it’s an all or none scenario. I have been taking Celebrex since 2005,
200mg and exams show me to be a physical specimen. I sense either bias or a hole in your research. As a matter of fact, I have followed findings very closely since Booz etc.
I have just published an article on the latest update of the Beers Criteria: Medications Older Adults Should Avoid or Use with Caution: The American Geriatrics Society Beers Criteria (2019 Update).
For all NSAIDs, the recommendation is “avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent,” irrespective of dose.
That said, I would say that the risk of NSAIDs is related to the dose and potency, so smaller doses are less risky. For those who conclude they must use NSAIDs (ideally in partnership with their health providers), I would recommend asking to be on the lowest dose necessary. This may require telling the clinician you want to try a lower dose, and then reporting on how the symptoms were on the lower dose.
I use excedrin + extra strength tylenol foe severe gout pain. I now read that Calif is thinking of banning Tylenol and Excedrine which contains tylenol because of heart and liver problems. How can you still recommend people take these OTC drugs in amounts that would combat severe chronic pain?
Well, my take on the “ban” is that consideration is being given to having a warning placed on acetaminophen, regarding its potential to increase cancer risk – a potential that is not very clearly established.
As Dr. K points out in her answer to some of the other comments, acetaminophen is a fairly weak analgesic (“pain-killer”) so for severe pain, it is usually not 100% effective, and at doses recommended by the manufacturer and most pharmacists and doctors, it’s not likely to cause significant liver injury (and it’s considered to be heart safe).
Now, excedrin contains caffeine (which can exacerbate some heart issues, like irregular heart rhythm) and aspirin (which can irritate the stomach and increase bleeding risk), as well as acetaminophen. It may be that these non-acetaminophen compounds are what is helping your gout pain, although we often use colchicine (an alkaloid) or prednisone (a corticosteroid) to reduce the inflammation of gout flare ups.
What can you use for a swollen hand
Swelling can be a sign of inflammation, especially if there has been an injury, or if there’s a chronic joint issue, like osteoarthritis. On the other hand (no pun intended), swelling of a limb can indicate a problem with drainage of fluid, from a vein or a lymph vessel. If it’s related to arthritis, I would try to use acetaminophen, as it is safest. Topical treatments (like a capsacin or NSAID ointment) might also be helpful. But determining the cause is the first step.
What about for tooth painkiller meds like panadolForte 500ng who bad is it for older people
I haven’t hears of that before but I think “panadol” is also known as paracetamol, which is the same as Tylenol (generic name acetaminophen), so you could consider it as being similar to the acetaminophen discussed in the article.
I am having pain in my ribs and slightly cough and white mucus and sometime not full breath I think it inflammation in my chest acetaminophen tab is advisable. I am 63 years old.
Hi Anil and I’m sorry that you’re having these symptoms. Acetaminophen can help with pain from inflammation of a muscle or other tissue in the chest, but if I saw a patient with this kind of pain along with trouble breathing, cough, and mucus, I’d want to do a full physical examination to see if a chest x-ray or other intervention is needed. I’d advise someone in your situation to see a doctor or health care provider right away.
Hi Dr. Kernisan,
I am an adult daughter of a mom who recently turned 95 years old. She fell and hurt her shoulder and an MRI showed rotator cuff tears as well as arthritis. She is in horrific pain. Her GP and heart doctor prescribed 5 pack Medrol which she took according to directions. It had no effect on her pain. Instead, she experienced and is still experiencing debilitating side effects: dizziness, nausea, insomnia, blurry vision, foggy brain and EXTREME WEAKNESS.
My mother is an amazing woman. She had eleven children, is very selfless, quite religious and loved by all. Previous to her fall, she had some balance and dizziness issues and she used a walker. She is also very cognitively aware.
We are beside ourselves. The doctors want to give her a steroid shot in her shoulder. We don’t understand why they are suggesting that considering her strong reaction to the Medrol. Now they are suggesting Trammadol for pain. Another drug with serious side effects similar to the Medrol and she refuses to take it.
We are considering Tylenol with codeine and are wondering what your opinion of that would be.
Here are her other medications:
Tylenol, extra strength which she takes regularly–I’m afraid too much. She usually takes two at a time, two or three times a day. It has not helped her shoulder pain.
Ativan 0.5 mg as needed for occasional anxiety.
Heart/BP medications:
Tykosyn 125 mcg 1 twice daily
Hydralazine 25 mg 1/2 tab in the morning, 1 pill in the afternoon and 1 and 1/2 at night
Isisorbide mononitrate ER 30 mg tablet extended release 24 hr, a by mouth twice daily
Allergy:
Azelastine 0.15% (205.5 mcg) nasal spray (which she stopped because it is a steroid)
She has been instructed to also take:
Vit D 2000 units 1/day
calcium-magnesium moo mg each as needed
Vit B12
B complex
Vit C 100 mg tablet 1/day
Mother also needs to urinate frequently and especially frequently during the night. The doctor prescribed Trospium. Do you have any experience with this. Side effects are awful and considering mom’s sensitivity to drugs, she doesn’t want to take it.
And finally, we would seriously consider cannibis as an option if we knew what kind to give her. Any thoughts on this.
She lives in San Antonio, Texas. Do you know of any good geriatric doctors there?
I look very much forward to your reply.
In sincere gratefulness,
RLR
Thanks for the detailed information about your mom. It sounds like she is really suffering after that fall and injury to her shoulder.
As Dr K mentions in the article, acetaminophen is the safest OTC pain reliever for most older adults, but it isn’t effective for everyone. We usually discourage codeine in older adults, as it is more likely to be ineffective and cause nausea and constipation. Tramadol is also in the opioid family but has actions on other cell receptors as well, and is often used for acute pain. Opioids can be used in older adults with some caution. For example, I often use very low doses of hydromorphone (0.5 to 1 mg) when I am treating an older adult with severe pain.
Medrol (solumedrol) is a powerful anti-inflammatory steroid, and a form of steroid can also be injected directly into the joint which is often the way it’s used in a rotator cuff tear. Some types of rotator cuff injury require a surgical repair unfortunately.
Urinary frequency can be related to many different issues and not all types of incontinence get better with medications like trospium, which can cause dry mouth and constipation, as you may have already experienced. Check out the article on incontinence for more information.
And finally, cannabis shows promise in the treatment of pain and anxiety, but it’s not currently considered a mainstream treatment for acute pain due to an injury. And just like more traditional medications, cannabis can have side effects too.
If you’re looking for a Geriatrician, the American Geriatrics Society has a helpful tool, which you can find here: https://www.healthinaging.org/find-geriatrics-healthcare-professional
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
Using the “endless loop flow chart” to effectively cancel opiates covers it. It is Medi Cal’s answser.
My Dr. says DON’T TAKE ACETAMINOPHEN it is bad for your liver. My liver function test results show high enzyme rates in Alk Phos, Alt, and SGOT. We are working to discover why they are so high. How can Dr.s have so many, completely different, opinions? Patients can be stressed enough without having to debate which opinions are correct. It is most confusing.
I can understand that there’s a lot of information out there and some of it can seem conflicting.
Acetaminophen (aka Tylenol) is metabolized in the liver, and at very high doses, or if a person has specific metabolic, medical, or genetic factors, the metabolic pathways can get overwhelmed and lead to the formation of toxic substances. In cases of extreme overdose or poisonings, this can cause serious liver failure.
Therapeutic doses of less than 3000-4000 mg per day are considered safe for the liver in most cases. If a person has a liver issue, or consumes a lot of alcohol for example, then they should avoid acetaminophen, but for everyone else, it’s reasonable to continue to use it as directed by your doctor or pharmacist.
Thank you for information I will Keep in mind these important values when taking anti-inflammatory medication.
Taking NSAIDs… really caused my face to break out in blisters, rash… quite painful….
I am having knee problems and have been told to bring the inflammation down with either A level or Ibuprofen. I’m 63, have a history of IBS abd I’m worried about taking these drugs, but I can’t just keep limping around. I guess my question is which is worse, in all respects — Aleve or ibuprofen? I have to take an anti-inflammatory, not just a pain killer. Thanks very much.
Alleve is the brand name for naproxen. Both naproxen and ibuprofen are NSAIDs. Research studies suggest that there is a higher risk of gastrointestinal bleeding with naproxen than with ibuprofen.
Given your history of IBS (I’m assuming you mean inflammatory bowel disease), I would recommend talking with your gastroenterologist before starting an NSAID for knee pain. NSAIDs do often help with knee pain however there are other ways to manage knee pain and I would recommend trying as many of those as possible. Even a topical NSAID cream will be safer, as you won’t be exposing your bowel to the medication. Good luck!
Joan,
I lived several years with a couple of arthritic knees. Now at 76, both are replaced.
Pre-op at my request my personal doctor prescribed a topical liquid NSAID (Diclofenac Sodium solution, 1.5% w/w), 40 drops rubbed on my knee up to 4 times a day. PENNSAID was the original brand name, now less expensive generic versions are available.
It gave me both near-immediate (t<10 minutes) local pain relief and reduced my joints' inflammation. While the product sheets said "use 4 times a day" I found I could use it much less frequently, as needed (most often at bed-time). It also served during recovery after surgery.
There are OTC creams with the same but less concentrated active NSAID (Voltaren is one such brand) but I did not care for its smell, feel or less precise dosing… and our drug insurance plan does cover the prescription but not the OTC.
I'd appreciate hearing a bit more from Dr. Kernisan about the comparative side effects and other uses of these topical NSAIDs vs "treat the whole body" NSAID pills.
Thanks for sharing your story. Yes, topical painkillers can be effective and certainly are safer, because they don’t expose the entire body to the action of the drug. I share some more information on topical painkillers in this comment, and have also recently added a few updates to the article itself.
It would be helpful if you included more natural types of remedies. For example, what’s your take on such things as turmeric as an anti-inflammatory which is often the cause of pain?
Natural remedies are a bit outside the scope of my expertise. I mostly write about what I know best, which is helping older adults avoid the many harms they often experience from commonly used allopathic (also known as “western medicine”) treatments.
If you are interested in nutritional approaches then I would recommend working closely with a clinician who has training and experience in that area. To learn more you might also take a look at NutritionFacts.org, which seems well researched, and has several videos on turmeric research.
What about using NSAIDs in cream form. You say that aspirin is not used for pain anymore but I find that it is the only thing that works for me if I am avoiding ibuprofens—would something like aspercreme be safer than aspirin tablets for occasional arthritis pain. Acetominphen does absolutely nothing for me.
Yes, topical NSAIDs are certainly safer than oral NSAIDs, because most of the body is spared from the NSAID. A recent Cochrane review concluded they are effective, see here.
However it’s important to distinguish between topical NSAIDs, which here in the US are prescription only, and what we call “topical rubefacients,” which are the OTC pain creams — such as Aspercreme — available in the drugstore. Although those products do contain salicylates, their main action is to dilate small blood vessels in the skin and create a sensation of heat. This does seem to bring some people a sense of relief but apparently is not anti-inflammatory in the same way that prescription topical NSAIDs are. This Cochrane review on topical rubefacients concludes that “in chronic conditions their efficacy compares poorly with topical non-steroidal antiinflammatory drugs (NSAIDs)” and “Topical salicylates seem to be relatively well tolerated in the short-term, based on limited data.”
In terms of safety, yes topical is safer than oral, and aspercreme for occasional arthritis pain is likely to be safe for most people.
But as always I would encourage you to talk to your doctor about your pain and also ask about a more comprehensive and holistic approach…there are many non-drug approaches recommended by the American College of Rheumatology, including exercise and weight loss. You can learn more in this Arthritis.org article, which notes that “Despite the availability of treatment guidelines and recommendations, only 5 to 10 percent of clinicians manage patients in a way that is consistent with them.”
Your articles are much appreciated. Could you comment on paracetamol please, the most popular over the counter choice in Australia? Thank you.
Whoops. Acetaminophen is the term used in the US for paracetamol. So presumably in Australia paracetamol would generally be the safest OTC medication for an older person, but you should check with your local geriatricians to confirm.
Sorry for the confusion; I actually mentioned paracetamol in an earlier draft of this article but somehow that detail was edited out. I have updated the post with this information.
In India the government has recently banned the manufacture and sales of PARACETAMOL combined with 50mg caffeine. If it is safe, why they have banned it?
Not sure. A health provider in India might be better able to answer your question.
Thank you for this article. Would you please write one about medications for rash/eczema relief. My doctor prescribed a 1% cortisone which doesn’t help. I ‘m taking a generic 20mg loratadine tablet no more than once in 24 hrs, less if possible, and I’m also using acetaminophen, especially at night. I’ve avoided benadryl since I read a previous article by you about dementia.
Thank you.
Sorry but dermatology is not a strong point for me. Dry skin is indeed common in older adults, but otherwise there is a looonnnggg list of things that can cause rash, so it’s not feasible for me to write about medication to treat rashes.
I will say that 1% cortisone is quite low potency, and I believe it’s common for clinicians to start with a low-potency cream and then consider a stronger one if necessary.
If a rash or itching is bothering you, it’s important to bring it up to your doctor; let him/her know the treatment doesn’t seem to be working well enough. You’ll want to check on whether your rash has been correctly evaluated/diagnosed, because correct diagnosis helps determine an effective treatment. If your rash so far has been managed by a generalist, you might consider asking for a referral to a specialist.
Re Benadryl, if your doctor thinks your skin might benefit from an anti-histamine medication, then it might be possible to get an antihistamine in a topical form rather than oral form, which will help avoid many of the anticholinergic side-effects.
Good luck finding answers and relief.
Florasone cream org natural made by B&T excellent for rashes, itching.
Hi Anne. From doing a quick look up on Florasone, they report that the active ingredient is cardiospermum, which is derived from the soapberry plant. It isn’t marketed for pain relief, but it might relieve the discomfort from itchy, dry skin. It also contains glycerin, which is a humectant (moisturizer). If it works for you, I’m glad and thanks for sharing this info.
I am 87 years old and in good health except for a pacemaker which causes no problem. My doctor did tell me 2 weeks ago to reduce Ambient from 10 mg to 5 mg because of potential balance issues. I was unable to walk with one foot directly in front of the other. Sure enough I fell twice last week. I did not trip over anything or slip on a wet surface. I was stepping up on a curb, then was walking on a carpet. I have never fallen before. I hesitate to name my medications here but would very much like to talk to you about them and get your thoughts.
Sorry to hear of your falls but glad you are trying to take action.
Zolpidem (brand name Ambien) is indeed a medication associated with falls in older adults, so in most cases it’s a good idea for seniors to work with their doctors to taper off of this medication if at all possible. Insomnia can be successfully treated with cognitive-behavioral therapy and other approaches. For more on this, see:
10 Types of Medication to Review if You’re Concerned About Falling
5 Top Causes of Sleep Problems in Seniors, & Proven Ways to Treat Insomnia
Many people your age can also improve their leg strength and balance by doing a structured physical therapy program, such as Otago. You may want to talk to your doctor about whether a physical therapy evaluation might be helpful for you. More on Otago is here: Otago & Proven Exercises for Fall Prevention.
Unfortunately, I cannot speak or email with you or anyone else privately about their medical concerns. But I am happy to provide information by answering comments.
I also sometimes offer a live fall prevention workshop, which allows the audience to ask me questions in real-time. For more see How to Personalize Your Fall Prevention Plan.
Good luck and do keep working with your doctor to address this important health issue. The process of evaluating and address fall risk factors often takes weeks to months, when done correctly.
Thanks for sharing Leslie. The warning signs are really helpful. The side effects of NSAIDs are an eye-opener. A high dose of daily medication can cure one thing and damages another. Most of the people nowadays use pain killers very frequently. Self medication can be dangerous sometimes, and seniors often make bad judgments and the family members should be careful about it. I would like you to write about the common myths of senior medications too. That`s a wide topic too I know, but do think about it though.
I think the problem is less about “bad judgments” and more that people simply aren’t informed enough about the risks of certain medications, and safer ways to manage pain.
Glad you find the article helpful.
What are you considering “older”…40..50…55…?
In the US, the term “older adult” is often used for people who are aged 65+, in part because that is when they qualify for Medicare.
I generally think that it’s sensible to become careful about medications once one reaches one’s early sixties.
I am 69 years old and am having trouble staying asleep at night. Falling asleep is no problem, but I usually wake up about 4 a.m. and my mind is racing with thoughts about things I have to do during the week. I usually lie awake for hours before I fall asleep again.
I started taking 5mg. of melatonin (OTC). Is this harmful to my health?
Melatonin actually seems to be pretty safe in older adults, and is likely safer than most other sedative or sleeping pill options that are available.
That said, if you are waking up at 4am and then experiencing racing thoughts, I would also encourage you to look into some non-drug techniques that can help you quiet the mind and relax enough to fall back asleep. Online cognitive behavioral therapy programs, such as SHUTi and Sleepio, have been proven to be effective. I also know of a chronically wound up person who greatly improved his insomnia using the Headspace meditation app (there is a series specifically designed to help people improve sleep).
I cover proven treatments for insomnia in this post:
5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia
Good luck!
Sometimes I wake at night with my mind dwelling on some issue and getting stuck in it. I’ve found a generally useful treatment is to do a crossword puzzle. My mind is racing, like it “wants” to operate fast, but it’s stuck on topics that cause more excitement, so around and around we go. A crossword puzzle gives my mind a chance to work well, but there’s no emotionally arousing theme, and after 10 to 20 minutes I’m more tired and can go back to sleep.
You probably know of recent historical research about “first sleep” and “second sleep.” Seems that people usually went to bed when it got dark (pre electric lights), woke after a few hours, did something useful but calm for an hour or so, then back to sleep. Like put some wood on the fire to discourage predatory animals from sneaking into camp and eating someone. But basically I find I feel better telling myself I’m experiencing a natural sleep cycle thing in being awake for a while rather than “I have a bad problem!”
That’s an interesting way to look at sleep! I’m sure there are many ancient memories in our human minds that we’ve turned into “problems”. Thanks for sharing your perspective and stay well.
Dear Leslie ! Thanks for an excellent and exhaustive narrative covering almost all aspects of treatment of pain with NSAIDs and other OTC prescriptions. I am 63 suffering from arthritis and knee pain. I have no other issues except that I take THYRONORM 50 for elevated TSH levels (T3 & T4 are NORMAL). My blood sugar levels are normal and BP is also normal. I take an occasional NSAID to relieve knee pain. I never exceed one pill per 24 Hrs period and never beyond three days at a stretch. All I want to know is which is better among ETORICOXIB, DICLOFENAC, PARACETAMOL & SERRATIOPEPTIDASE. Regards !
Paracetamol is called acetaminophen in the US, it is not an NSAID, and I explain the pros and cons in the article.
I can’t say which medication is best for you, especially since two of the ones you mention are not used in the US. I would recommend you discuss further with your usual clinicians. Good luck!
When I had ulcers caused by the combined treatment of aspirin with NSAIDs I was told that Acetaminophen was “NSAID-like” and that I should never take it or NSAIDs. This perspective may be helpful to consider under circumstances where NSAIDs are not recommended.
I’m sorry to hear about your ulcers, and they can be associated with NSAIDs or aspirin. Taking an NSAID can increase the risk of a peptic ulcer fourfold in fact.
Acetaminophen doesn’t affect platelets (blood clotting factors in the blood) the way that NSAIDs and aspirin can, so it isn’t a cause of bleeding in the gastrointestinal tract. Most people who’ve had ulcers can safely take acetaminophen, unless there’s another issue like a liver problem.
A discussion with a doctor or pharmacist should be able to clarify is acetaminophen is OK for you.
Is a200 mg tab of Motrin taken 2 x a day, 12 hours apart ok for a 74 yr old female. I take this amount 3 days a week. It’s the only med that gives me any relief at all from osteoarthritis.
Well, a lower dose is generally considered safer in that it’s less likely to cause side-effects or adverse events. Your dose is certainly lower than many.
I can’t say whether it’s “ok.” How risky it is really depends on your other health factors, such as your other medications, your kidney function and whether you are at higher risk for bleeding in your stomach or bowel.
I would recommend discussing your concerns with your usual health providers. You may also want to ask about other options for managing your arthritis pain…sometimes non-drug approaches can be quite effective. Good luck!
Dear Leslie, somehow at 35 I got “lucky” and was diagnosed with arthritis, I’ve been managing pain, by trying to ignore it, for over 10 years now, first it started in my knee and now it spread to almost all of my joints. I try to stay away from pain medications, unless it’s extremely necessary, but right now I’m at the end of my rope, the pain is effecting my everyday life and I don’t want to feel like invalid.
When I read your article, I was ecstatic about trying acetaminophen, as it seems to be the lesser evil, although toxic epidermal necrosis does worry me, but it seems to be extreme rare side effect.
But in my follow-up readings, managed to find an article from Cochrane Library published in June 2016, article called its effectiveness into question. Now I am at loss. So is it worth trying?
Sorry to hear of your arthritis. Obviously, I don’t have particular experience treating people your age, but it sounds unusual to have so much arthritis pain at your age, and your arthritis may be different from the more “garden variety” late life aches and pains that I mention in this article.
In general, acetaminophen is considered a weak analgesic. I would not expect it to make much of a dent in significant arthritis that is otherwise affecting everyday life. NSAIDs are usually found to be more effective in reducing pain, both in research and in people’s experience. But, at usual doses, they have more risks, especially as people get older.
You may want to look into a more “holistic” approach to managing pain and arthritis in people your age, such as that done through functional medicine. It’s not always easy to find evidence supporting every aspect of their approach, but many people seem to find it helpful. Just google functional medicine arthritis. Good luck!
Thank you for your caring information.
you’re welcome, glad to help
I have been taking Gabapentine for beurological pain in my lumbar spine while recoveting from a TKR. I was on opioids along with the Gabapentine, but they were hard on my digestive tract and I stopped taking them as soon as I could. Is Gabapentjne safe for seniors?
Gabapentin is technically an anti-seizure medication, it works by reducing the excitability of neurons in the brain. It can also help treat pain related to nerves, and is FDA-approved for the treatment of post-herpetic neuralgia (nerve pain after shingles). Its effectiveness in treating other types of pain has been questioned, see here and here.
In terms of its safety, it’s generally been considered “well-tolerated”, especially compared to some of the other alternatives. It does often dampen brain function a bit (as to be expected, since it’s an anti-seizure medication).
When considering whether to continue a medication, you’ll want to think about whether the benefits justify the risks. Gabapentin is not particularly risky, but you may want to be sure that it’s providing good pain relief before deciding whether or not to continue. There are effective non-drug ways to manage chronic pain, but they can take some time to implement. Good luck!
My grandmother who is of 88 years has been taking diclofenac 50 mg once daily for more than 15 years without side effects. What do I do?
I would recommend discussing this with her prescribing doctor. As people get older, it becomes more common for them to have some mild kidney dysfunction. They are also sometimes at higher risk of bleeding. Your grandmother’s doctor can help your grandmother and your family determine whether the benefit of this medication outweighs the risks, given her particular health situation. If she is at low risk for bleeding and her kidneys are working well, then it may be reasonable to continue, especially if stopping the medication would cause any chronic pain to get worse. Good luck!
Thanks for clarification. At age 79 last year I made an emergency room visit–my first hospital visit ever. I drove myself there due to a protrusion in my abdominal area begun due to heavy coughing from a bronchitis 10 day problem. At my arrival, I was asked to sit in a wheelchair-the next thing I heard was
60 over 40 and I awoke in intensive care from a major hematoma which I had never heard of. It was contained inside a large muscle and I was released 2 days later to rebuild my blood lost inside the hematoma. It was several months before it was absorbed by my body. I had been taking daily Advil for muscle-joint discomfort from a back problem I did not know was serious. I still was not told by any of my several routine doctors about NSAID until I asked last week and was told to use tylenol rather than advil.
Thanks for sharing that story. Yes, that illustrates why NSAIDs are considered risky in older adults! Glad you were able to get emergency care in time.
Thanks so much for sharing this article. —Very helpful.
Glad you found it useful.
I have intense burning and itchiness on my skin, especially the lower back. I use creams (1 percent hydro cortisone and clotrimazole) for relief but also use Benadryl upon retiring. It helps the itchiness thru the night I take one half tablet during the discomfort time and consume approximately a 60 tablet bottle over a two year period. What are the side effects I should be aware of.
I am 80 years young.
The problem with diphenhydramine (brand name Benadryl) is that it is quite anticholinergic. Anticholinergic drugs interfere with acetylecholine, a neurotransmitter that is important for proper brain function. Chronic use of anticholinergic medications is associated with a higher risk of developing dementia, and seem related to the cumulative dose. I have more information in this article
4 Types of Medication to Avoid if You’re Worried About Memory
Probably it’s a little safer and better if you can find a way to manage your itching without Benadryl. Would more moisturizers or other creams help? I would recommend talking to a dermatologist and asking for help. Be sure to specify that you’d like to minimize your use of oral anticholinergics. good luck!
My mother was given Tramadol and told she could take that or Tylenol, so I try to give her the Tylenol instead – but was wondering if Tramadol affects the mind more? Seems like her confusion and drowsiness get worse with Tramadol. Tried Gabapentin also, and it almost knocks her out. Do pain medicines make people with dementia worse?
Tramadol does tend to have more “psychoactive” side-effects, so I almost never use it. Gabapentin is often well tolerated but not by everyone, sounds like it’s very sedating in your mother. (It’s also probably mainly effective for nerve pain and not so much for other types of pain.)
One problem with Tylenol is that it’s really not a very strong painkiller. It can help a little bit in some cases, but rarely is effective for moderate or worse pain. And it’s not anti-inflammatory, so tends to provide less relief than NSAIDs do. So it’s safer but usually less effective from a pain management perspective.
In terms of other pain medications making a person with dementia worse, it depends on the medication and on the person. It is sometimes necessary to do a little trial and error, and it’s always a good idea to start with a very small dose. good luck!
Hi, my mother is 71years old she was complaining from menescus tear , osteoarthritis,inflamed knee joint, her doctor advised her to take anti Cox group of anti inflammatory or diclofinat ..what’s your opinion
As explained in the article, the anti-inflammatories you describe are known to be risky in older adults, especially if taken daily for chronic arthritis. So, it’s generally advisable to try other ways to manage the arthritis pain before resorting to oral NSAIDs. Topical NSAIDs can provide some pain relief with less risk of kidney dysfunction, bleeding and other systemic side-effects.
For older adults considering oral NSAIDs, it’s important to discuss the risks with prescribing doctor and to check that safer alternatives have been tried. After that, some older adults or families decide the risks of NSAIDs are acceptable to them.
What is most important is to be well-informed and also to try other approaches before resorting to a risky medication.
I was diagnosed with Degenerative Disc Disease a few months ago. Unable to sleep one night I took an Excedrin PM. My pain was much less the next day. Not wanting to take diphenhydramine regularly I tried Claritin as it seems to have less side effects. So far it has reduced my pain considerably. Do you know why this would work for pain?
I don’t usually think of loratadine (brand name Claritin) as a pain medication. I looked quickly on Pubmed (the free database for medical literature) and there are case reports of loratadine being effective for bone pain, although it’s not clear to me that the mechanism for this is understood (or even that it works for most people).
Loratadine is considered safer for older adults than diphenhydramine, because it is less anticholinergic. I would recommend that you discuss with your health providers before continuing to take it long term, but I would think occasional use would be low-risk.
As an additional comment on use of Claritin for bone pain, I was actually advised to take it during chemotherapy given one of the drugs in the mix caused intense bone pain. I found it worked The doctor also mentioned that this result was based solely on the experience of patients.
what is your view of optalgil for elderly patients?
This is not a medication we use in the US, so I cannot comment on it.
I wake up at 1;30 – 2 AM. Sometimes with a headache . I take one metoprolol and this works . My normal is one in the morning an one at night.Along with hydrochlorothiazide , losartan , diltiazem and pravastatin at night. About 15 yrs.like this. I am 72 and a viet nam vet. I also take medformin for diabetes type 2 and tomsulosin for enlarged prostate . I walk a mile 3-4 times a week .Also stand 3′ back from the kitchen sink and touch my chest to it 40 times 3-4 times a week also.
hm. Metoprolol is a heart medication that is sometimes used for high blood pressure. That is interesting that you find it works for your headache. We generally wouldn’t recommend using metoprolol in this way, in part because I don’t think it’s been studied for this purpose. I would recommend letting your health providers know that you’ve been doing this, they should be able to advise you as to how to manage your headaches.
Hi Leslie,
Great Article and replies to comments! My mother is 82 with early dementia…some days better than others. She takes daily aspirin (81mg) for arteriosclerosis (carotid and renal) and delayed release acetaminophen (650mg tables x2) for arthritis pain. Her liver function is fine and even though she has some kidney issues, her kidney function is still good.
Recently she fell on the ice and hurt her wrist so she took something stronger that my father had (I think it was Lenoltec). It helped her pain but I’m worried about her cognition, as it has been worsened by sedating substances. In fact, they gave her hydromorphone via IV last year in hospital and her cognition was not good while on it.
What is the best medication she can take for the acute pain? I’m considering additional Aspirin for it’s anti-inflammatory properties but worried about bleeding risk given she’s already taken daily low dose. I also thought about giving her 1000 mg dose of Acetaminophen when her pain is bad either in combination with the delayed release or stopping the delayed release? Of course staying within the 4 g daily limit. I also have other opioids on hand besides the lenoltec- 1mg Dilaudid and Tramadol but worried about giving them re: cognition. I’m leaning towards starting with the 1000mg acetaminophen. In the meantime, I rubbed on some over the counter topical voltaren and of course Icing, elevation, immobilization. It didn’t swell up as one would expect with a broken wrist and it’s not deformed so likely a bad sprain or maybe a small fracture.
Again, this is just for very acute moderate pain until we can get the wrist looked at. FYI: her GP and other doctors she has seen in the past are not well versed on pain management for this class of patient so I have to be proactive. Thank you.
Sorry to hear of your mother’s fall and wrist pain, I hope it’s gotten better by now.
A topical choice is often a good idea, because those have less systemic side-effects.
As medical professionals, we no longer use aspirin for pain, only for its cardiovascular prevention properties.
For extra pain, we sometimes try NSAIDs for a limited period of time, provided the person has ok kidney function and doesn’t appear to be at high bleeding risk. Aspirin itself increases bleeding risk, so that should be considered when weighing the risks and benefits of using short-term NSAIDs.
Otherwise, we do sometimes use low-dose opiates, especially if topical and OTC approaches aren’t sufficient. Lenoltec is acetaminophen and codeine. People with early dementia have variable sensitivity to opiates, and may be more sensitive to some than others. Sometimes a little trial and error is needed. Tramadol is considered more psychoactive than other opiates, so I almost never use it myself.
I am 77 years old and have never had success from taking tylenol. Ibuprofen, Alieve and even the extra strength tylenol will not touch a headache for me. Since I was in my 30’s I get daily headaches mostly in my sinuses. I have always taken excedrin in the past which works great. Although it has been discontinued, excedrin had a product called “excedrin mild headache” relief. They had 325 mg tylenol and 65 mg caffein in each tablet. It worked great with less medication. I was very disappointed when it was discontinued until I did some experimenting. I now take one half of a 200 mg caffein tablet (100 mg) with two 325 mg regular strength tylenol and it works great and with lower dose medication. Somehow the caffein increases the effect of the tylenol. Works for me!
My father is almost 101 years old with sound mind. He is on Coumadin and other medications. He has very painful arthritis in his toes. What do you think about creams that contain Cannabinoids (such as Receptra Targeted Topical to name a few) ?
Thank you.
I don’t have any personal experience treating pain with cannabinoids, much less in someone his age. In general, creams tend to be safer than oral medications. Many families (and some health providers) are trying out cannabis-based products. It is too soon for us to have well-done clinical trials to guide us, however.
I would recommend talking to his doctor about the pros and cons of trying this for the pain. It may be reasonable to try, especially if you can help monitor for side-effects (and also for effectiveness, to make sure he’s actually benefiting). Good luck!
You look so busy I hate to ask, but I’m a 77 year old guy with leg rendon, knee, and some back pain. Ex jock. Osteoarthritis in knees. I take 100 sometimes 200 mgs of ibuprofen sometimes daily, sometimes every other day or I can’t walk very well. I am on no other medications, my blood work is perfect. Am I in any serious danger taking that dose?
It doesn’t sound like a very high dose, which is good. How risky it is depends on the state of your kidneys, whether you’re at risk for ulcers or gastrointestinal bleeding, and some other factors relevant to your health history. I would recommend asking your usual health provider to discuss how risky this is likely to be for you. It would also be a good idea to explore other ways to manage your knee pain, either via topical medication or via non-drug methods. Good luck!
My father is an active 83, and has increased daily back, neck, pain due to nerves. Has rod in his back. He is an artist, I sure years of poor posture has helped contribute. Doctor has told him tramadol will do nothing and at his age has to live with the pain. He is on Elaquis and we definitely don’t want to take anything that will make him fall. He is walking for exercise and taking physical therapy with use of electrodes also. He is not overweight takes and another BP pill. Gabapentin 300 mg, 2x day.
His ability to sleep at night is getting worse and seems this is when the pain occurs most. What can be done for nerve pain?
I hate to see him have to be reduced to having to just live and bear it. The ability to not be as active seems to be bringing on some depression.
Sorry to hear of his pain problem. Unfortunately, neuropathic pain can be hard to pharmacologically treat in general, and is especially challenging in older adults because the medications for neuropathic pain tend to have particular risks and side-effects that are more pronounced in older adults. In other words, the medications often used for neuropathic pain tend to affect either brain function or balance or both.
The options for treating neuropathic pain in older adults are reviewed here: An Algorithm for Neuropathic Pain Management in Older People
I would also recommend looking into a program for self-management of chronic pain, such as this one, which has been studied and shown to be helpful: Chronic Pain Self-Management Program
Thank you for this very helpful article. I’ve just learned that my 90 year old mother in law has been taking 1300 mgs of aspirin a day. After reading your post, it seems that she should discontinue the aspirin and switch to Acetaminophen, however, despite many hours of research I can’t find any recommended tapering schedule – especially for such a high dose – and am of course worried about the reported increases in CV events following aspirin discontinuation. Her physician was unable to help. We will be grateful for any suggestions you may have.
Hm. Well, I have not heard of any tapering schedules for such an aspirin dose, especially in someone her age. I think you are in medically uncharted waters.
That said, I am a little surprised that her physician was unable to help and am wondering what he or she recommended. Continuing such a dose sounds a bit risky, so even if we have no guidelines or specific medical literature to help us know the “best” way to bring it down, I would think something still needs to be attempted, and it is for the involved physician to do his or her best to propose something.
You may want to start by asking the physician for help getting her down to a “usual” dose of 81mg per day, and then you could discuss whether or not to try stopping it. You could also try asking a pharmacist for advice. Good luck!
Yes, there is a tapering off schedule for aspirin. I read it on the internet.
The article cited the dangers of going off aspirin “cold turkey”. It can cause
a heart attack to do so. Try finding this info. I cannot remember what I used
in “search” but I do not think it will be hard to find. You will have to keep
a schedule and it may take a while to get off the aspirin but well worth it.
I must mention: on none of these posts does anyone speak about using heat and cold for some pains.
I agree that it’s worth considering whether heat or cold might alleviate aches and pains. How likely they are to help may depend on the underlying cause of the pain, so I would recommend checking with one’s health provider for guidance.
Regarding aspirin: in general medical practice, we have not usually tapered the dose of baby aspirin when people stop. Now, an observational study published in 2017 did conclude that stopping aspirin was associated with a 30% increase in the relative risk (not the absolute risk) of having a cardiovascular event; the authors said this corresponded to “an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin.” So there is an increased risk but in absolute terms, it’s not very big.
Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events.
To date, I cannot find any articles published in Pubmed on the tapering of aspirin that is prescribed for cardiovascular prevention; I doubt it has been studied yet. I have not yet had a chance to ask my academic cardiology colleagues if they are changing their practices in regards to stopping preventive aspirins.
. I have RLS and i struggle with it. I take Pramipexole usually 2 each evening space about 2 hrs apart. I have tried Requip and Gabapaten but with no success. It t sometimes requires 3 Pramipexole to quiet my RLS. Would you have any other recommendations? Thanks for your time and help
Pramipexole is not an over-the-counter medication; as I imagine you know, it’s a prescription medication sometimes used to treat restless leg syndrome (RLS), and also certain other conditions.
If you are looking for help treating RLS, I would recommend talking to your usual provider, or getting a second opinion from a specialist. You can also try searching Pubmed for “restless leg syndrome treatment”, if you want to do some research before seeing your usual health providers. There are free full text articles available, you can probably find a good review article summarizing treatment options.
Last but not least, another option to research treatment options is to find a patient community online. Good luck!
Dear Dr, Kernisan; I read your Comments regarding aging adults, their pains, and all the OTC medications. It is very interesting. One question I have, is Acetamenophen Extra Strength 500mg the same as Tylenol Extra Strength 500mg?
For the last two months my arthritis has bothered me with extreme pain especially while sleeping.
My physician recommended Glucosamine Condrotin, which I am taking. So far, 3 wks, no results. In the meantime, I have taken Aleve12 for 3 days now, which has lessened the pain alot during sleep. I am very cautious about taking more than 1 pill a day.
Yes, in the US a common brand name for acetaminophen is Tylenol, so acetaminophen extra strength and Tylenol Extra Strength are basically the same thing.
Glucosamine is often taken for arthritis. Randomized blinded trials tend to find that the effect is negligible, compared to placebo, so I am not surprised if you find it’s not doing much. An NSAID such as Aleve usually does provide noticeable pain relief, but as noted in the article, it’s a little risky to take every day. You may want to consider a topical formulation. If your pain is getting much worse at night, I would also recommend making sure your health providers are aware, so that they can check for other causes of worsening pain. You may also want to ask for help with non-drug arthritis management, and some people find a chronic arthritis pain self-management program helpful. Good luck!
“Icy – Hot” patches worked wonders for me when I had sciatica. They were prescribed by urgent care doctor. He also said to take 3 extra strength Tylenol every 4 hours. That I did not do! It sounded too risky.
I found laying flat on my back was helpful along with the patches.
Perhaps using topical rubs can help many with chronic pain.
I wish you all well.
An extra strength Tyelonol usually contains 500mg of acetaminophen. So three would be 1500mg. I agree that seems like a hefty dose, and taking such a dose every 4 hours around the clock would quickly put one over what is usually considered a safe limit.
Topical patches are a great idea and anything topical is usually much less risky.
I have Hashimoto’s hyperthyroidism. I am miserable trying to feel normal. I have pain. I am allergic to Actephetimone. I can’t sleep. I have no energy. There are other problems. I don’t think doctors take this seriously. All they care about are blood tests and what they should prescribe. I never had a belly. All of a sudden there it was. I haven’t gained weight since.
Hm. If your usual health providers haven’t been able to help you with your symptoms and new changes (the belly suddenly getting bigger doesn’t sound normal to me), then I would recommend considering a second opinion. You could look for another “regular” healthcare provider. Or, sometimes people find it’s helpful to see a functional medicine specialist. These often are not covered by insurance. They tend to include more in-depth assessments that address lifestyle issues, nutritional triggers, and other factors often overlooked by busy allopathic health providers. (Many functional medicine providers also have conventional training and may be able to uncover less common medical conditions.) Good luck!
Wow, I had never heard this before. I heard acetaminophen was dangerous and have avoided it choosing NSAIDs instead. Although I ran out of my Sulindac, but thinking my Dr’s had me on this for years, I had forgotten why I was taking it. Last night after missing two doses I was awoken with horrible joint pain. I was looking for the best OTC NSAID to take until I got to my Doctor. Now I believe a cream I can use on my elbows, shoulders, hands, and knees will be my next search. Arthritis is what they tell me is the problem. I cleaned up my diet and am exercising more, but still need to find out what foods may be causing elevated pain levels. When the meds had it under control, it wasn’t a concern, but after reading this article I’m glad the bottle’s empty and I can search for safer alternatives. Thanks
Yes, creams are generally much safer than oral NSAIDs. You may also want to talk to you health providers about other ways to mitigate arthritis pain; often a multi-dimensional approach that includes suitable exercises, weight loss (if relevant), and other approaches can be very helpful. Good luck!
I’m helping an elderly relative (97) who is struggling with the pain of post-herpetic neuralgia after shingles. She takes a total of 500 mg of Gabapentin spread out in 3 doses (which doesn’t alleviate the pain but is concerned that more will have her sleeping all day). She was also advised to limit Tylenol to 2000mg daily-so she spreads out 3 doses of regular Tylenol in the day. As she tries to increase her activity level, the pain has increased and we wondered if maintaining the totals of each (Gabapentin andTylenol) but playing with timing/dosage would help. For example, would it still be safe for her to take two extra-strength Tylenol twice a day to hit the pain harder but still keep to 2000 mg—or is that too much for an elderly person at one time? She is on heart and BP meds, Her kidney function is low but she has no liver issues.
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
It is generally considered safe to take 1000mg of acetaminophen in one dose, as long as the daily dose remains below a certain level. Now, it may or may not provide much relief…acetaminophen is not overall a very powerful analgesic, and post-herpetic neuralgia can be very painful.
You could try asking her health providers if any topical analgesics might be an option.
If her pain is really severe and affecting her quality of life, it might also be reasonable to consider trying a very small dose of an opioid-type medication, such as a half-tab of Vicodin. You would need to discuss this with her health providers and if they do dispense any such drugs, it’s essential to make sure that they cannot be used or diverted by someone else in the house. (In my own experience, this is a bigger risk than addiction in a 97 year old).
Good luck, I hope she finds some relief soon.
I know NSAID’s can cause bleeding but Can Tylenol cause bleeding?
Acetaminophen (also known as tylenol, or paracetamol) has a much lower risk of causing bleeding than aspirin or ibuprofen, and is generally regarded as a safer pain relief choice for those at risk of bleeding. Of course, it’s important to talk to a health care provider before taking any medication.
My 81 year old mom can’t take NASIDS due to being on Eliquis, can’t take narcotics because they make her sick, and now can’t take Tylenol because of a severe allergic reaction. She has migraines, so what OTC pain med can she safely take??
Hi Lesa, sounds like your Mom has a bit of a dilemma. Migraine headache tends to be less common in older adults, with only 9% of those with migraine belonging to an over 65 age group. So, a first step might be to clarify whether the headache is related to migraine or to some other cause.
All of the pain relievers you mention can be used for headache, but depending on the cause of the headache, many other meds may be useful, for example blood pressure pills, antidepressants, anticonvulsants, or even prednisone. These are not usually sold over the counter, but they may be inexpensive, or covered by common drug plans. In addition to pills, other treatments can help headache such as massage, physiotherapy, mindfulness, acupuncture, and more.
The critical thing is to make sure you have the correct diagnosis and tailor the treatment to that. Hope that helps!
My 81 year old mom cannot take NASIDS due to being on Eliquis, Tylenol because of a severe allergic reaction, or narcotic pain meds because they make her sick. What OTC pain med can she safely take??
I’m surprised you don’t mention diclofenac (voltaren) gel, a topical NSAID available by prescription. I’ve had a lot of success with that in my patients with chronic back & joint pain (I’m an NP).
You are correct, some guidelines for the management of knee osteoarthritis do advise topical NSAIDs as a first line, but remember that even in topical therapy there is some systemic absorption, so some of the risks of NSAIDs are still present.
At 82 I’m in excellent health. I exercise regularly and eat a lot of fruits and vegetables. My one complaint are my knees. After 13 years my full knee replacement on my right knee aches a great deal, while my left knee is also bothering me. I see a knee specialist for the left knee, but am unsure what to do about the knee replacement as the surgeon does not take Medicare. I have found that 4% lidocaine patches have been very effective in relieving the pain. I put them on at night and cover them with a loose knee brace to keep them from falling off.
Glad to hear you are enjoying good health! In this article: “Topical therapies for knee osteoarthritis”, E. C. Rodriguez-Merchan (Postgraduate Medicine, 2018), the author reviewed the evidence for numerous topical (skin-applied) therapies for knee OA, including diclofenac, ketoprofen; capsaicin, cream containing glucosamine sulfate, chondroitin sulfate, and camphor; nimesulide; civamide; menthol; drug-free gel containing ultra-deformable phospholipid vesicles (TDT 064); 4Jointz utilizing Acteev technology; herbal therapies; gel of medical leech (Hirudo medicinalis) saliva extract; and gel prepared using Lake Urmia mud. They found that the NSAID based preparations were the most effective, according to the evidence.
In contrast, a Cochrane collaboration review found that there was no good evidence for the benefit of lidocaine patches, at least for nerve-mediated pain (aka neuropathic pain).
But if it’s working for you and your doctor thinks it’s safe, then I am glad to hear it!
I just read that the government is considering putting a warning on acetaminophen due to it’s possible dangers. Does this change your opinion of it or is it still related to how much is taken?
You make a good point, which I think is clearly covered in the article, that acetaminophen (or paracetamol) can need very careful use in those with liver disease, or who may be getting acetaminophen from other sources (i.e. in other OTC medications).
Rather than read through the voluminous # of comments before posing this question…
If one is going to use ibu occasionally or short term, what daily dosage limit ought one observe? If it matters, this one is a 180lb 67yo male.
Hi Bart. A ballpark for a daily recommended dose is usually printed on the side of the package for most OTC’s, but I would advise anyone to consult with their doctor, or with a pharmacist. Safe ibuprofen dosing depends on a person’s health history and what other medications they are taking, among other things.
Hi Bart, it’s Carla. I don’t know about you, but the standard wisdom on this topic as above drives me nuts, as much as I love Leslie and have for years. Too many draconian choices in which I have no choice but to ignore Leslie and the Beers list.
Tylenol is worthless for me, only Advil works. Meditation is a joke with my kind of mind and CBD oil did zippola too. Magnesium creams and spray help a bit once in awhile. But my chronic muscle pain is such (even as a statin refusenik) that Id have constant insomnia otherwise. So I take the risks,
Happy to hear there are are prescription NSAID creams, Will ask about that next.
Hi Carla and thanks for taking the time to leave a comment.
It’s true that the Beers list is a guideline, but not one that needs to be followed to the letter in every case. Every medication decision can involve a trade off, and it sounds like you know yourself and your body very well. If you understand the risks and make an informed choice, that’s a reasonable way to go.
Hope the topical NSAID creams work for you.
Having just read your latest blog about OTC pain killers (“safest-otc-painkiller-aging-risks-of-nsaids”); I find it very useful.
Many years ago (in my 50s) my GP recommended that I try glucosamine for very sore knees and my hips were becoming more painful. While it took a several weeks to relive the joint pain I have never had a recurrence. I have continued taking glucosomine daily (3000 mg) ever since. I am in my 70s and I would consider myself much more spy than the average male my age.
Hi Bruce. We have been hearing about glucosamine (a component of joint cartliage), taken with or without chondroitin for years, usually as a treatment for knee osteoarthritis. I recently read a meta-analysis of studies looking at glucosamine for knees osteoarthritis, and the authors concluded that it was better than a placebo for pain (Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis, Toru Ogata, et.al., CLin, Rheumatol. 2018; 37(9): 2479–2487.). The effect size was very small, however, so in the amalgamation of the 18 articles the authors analyzed, it was not MUCH better than placebo. I’m glad you are getting some results and feeling spry, though!
Thank you for your post about NSAIDs. I share your cautions about them. But could you please share other ways of reducing inflammation? I have osteoarthritis, piriformis-sciatica, and bursitis, all of which have inflammation as a component. Thank you ? .
Well, that’s a big question, John! One of the hot topics in strategies to reduce inflammation is the gut microbiome: the type of bacteria in a person’s gastrointestinal tract.
Many studies about the link between frail health in older persons and their gut microbes are ongoing, and I have also read a few research papers looking at how a modified diet can help to treat inflammatory conditions like rheumatoid arthritis. Most “anti-inflammatory” diets are low in salt, eggs, most dairy products, red meat, gluten and sugar and higher in yogurt, enzymatic fruits (like pineapple, mango, papaya), green tea, and turmeric, among other things.
Most physicians would also advise that adequate sleep, being a non-smoker, and avoiding stress is a good way to keep inflammation at bay as well.
Please comment about the possibility of alternating NSAIDs and acetaminophen when acetaminophen alone does not provide enough pain relief to allow a person to be functional, particularly for short-term “flares” of arthritis, wound pain, etc.
I found that taking 400 mg ibuprofen every 6 hours or 400 mg naproxen sodium every 12 hours with food, alternating with 500 mg acetaminophen every 6 hours (taken 3 hours after the ibuprofen, for example), provides amazing pain relief with very low doses. Because acetaminophen is primarily metabolized by the liver and NSAIDs primarily by the kidneys, toxicity is less of an issue than it would be with higher doses of acetaminophen. And, the anti-inflammatory action of NSAIDs can be very helpful to calm down pain from arthritis.
Hi Linda
I am not a clinical pharmacologist, and most of what I have read about alternating acetaminophen with ibuprofen is in regards to treating a child with a fever. Here is a little review article about that. Now these authors mention that there is a theoretical risk of increased toxicity to the kidney or liver as a result of the NSAID contributing to the production of a toxic compound when the acetaminophen is metabolized (I am simplifying, here!).
A study of combined ibuprofen and paracetamol (British for acetaminophen), for pain management after a hip replacement (the PANSAID randomized clinical trial), found that the combination was better than acetaminophen alone, but not better than ibuprofen alone. They didn’t find an increase in the risk of serious adverse events. So that would seem to suggest that using ibuprofen alone is the way to go.
So, after just looking into it briefly, I’m not sure that I would recommend the regimen you describe, but there isn’t a large body of good evidence to guide us in the matter.
I’m 73, apparently fit and healthy, except for some prostate-related discomforts. I don’t like the side effects of the normal drugs (Tansulosina etc) for prostate relief as they build up in the body and lead to low energy and attitude.
I find that 400mg of ibuprofen, taken as I retire, helps me sleep, dramatically reduces the nocturnal toilet visits and there is no sign now of the foggy brain and tiredness that `I had become used to?.
Is this a feasible and safe treatment?
I found this response from Dr. K. to a related question a few months ago. She rightly points out that we use NSAIDs like ibuprofen with caution in older adults, and usually not on a chronic or ongoing basis. I would suggest you speak to your doctor about whether this is the right way to use ibuprofen for you.
Thank you for the very informative article. I always find myself standing in the pain relief aisle not quite sure which pain relief medicine to choose. My doctor recommends Tylenol but I have always been an aspirin fan, but now through your article I understand and I will be making the move too Tylenol.
I know what you mean about all of the choices for pain relievers at the pharmacy! I’m glad the article was helpful to you in making a choice. There are definitely therapeutic reasons for some to use aspirin (for example if you have had a heart attack or stroke), but for pain relief acetaminophen (Tylenol) has a lower risk of stomach irritation and bleeding.
I have osteoarthritis in my spine. Unfortunately, there are no prescription medications for osteoarthritis, and I do not want to take anything potentially addictive. For my aches and pains, which can, at times, be considerable, I’ve been taking a combination of acetaminophen and naproxen. However, for whatever reason, acetaminophen has become all but impossible to find in these days of COVID-19, so I’m considering switching to ibuprofen, at least until acetaminophen once again becomes readily available.
Hi Linda and sorry to hear that you’re living with pain. For many older adults, the occasional use of ibuprofen can be safe but over the long term ew prefer not to use it, for the reasons Dr. Kernisan mentions in the article.
Don’t forget that the management of osteoarthritis includes more than just medications. Weight management, exercise, physiotherapy, even mindfulness or meditation can help with OA pain.
I have mild headaches and I cut a 500 mg
Tablet in half. 250mg gets rid of my headaches. The only prescription medication i take is phenytoin. Is it safe to cut the tablet in half, and does phenytoin have acetaminophen in it.
Most of the time, cutting a tablet in half is safe to do, but for some preparations, it may affect the effectiveness of the medication. For example, if the tablet has a special coating on it to make it a slow release or extended release formulation, then cutting into the coating might prevent that slower release. Acetaminophen usually comes in 325 mg strength as a regular Tylenol so that is an option for those who want a lower dose of acetaminophen.
Phenytoin (also known as Dilantin) is a medication used to treat seizure disorder and does not contain acetaminophen.
I have an aspirin allergy and but I’buprofen is usually okay I’ve never tried naproxen but heard from Caltech professors that the prescription version of naproxen has fewer side effects and is safer than the over-the-counter version. they think that difference is due to the chirality purity. prescription has to be about twice as good as the over-the-counter and that opposite chirality causes a lot of the side effects.
Your question raises a few interesting points, probably beyond what I can discuss as a Geriatrician (and not a clinical pharmacist).
There can definitely be differences in formulation and effectiveness between OTC and prescription types of drugs, and between generic and brand name drugs for that matter. This is permissible by most regulatory agencies, as long as the variation in the actual amount of active compound is within a certain range. There may even be variation between batches of mediation, even when produced at the same factory with the same ingredients. In some cases, this can affect how well the drug works (or clinical effectiveness).
In terms of chirality, this is a property of certain chemical compounds, which have different forms or enantiomers. You’re right that some enantiomers are much more effective than their opposite form, and are usually marketed as such (the antidepressant citalopram and s-citalopram for example).
From what I was able to find in a quick search about enantiomers of ibuprofen or naproxen, there hasn’t been much study since the mid 1990’s about whether the different enantiomers are more effective or more toxic, but the folks at Cal Tech may be more up to date than I am!
I’m an active 85 year old woman. I have painful osteoarthritis in my knees and my back, along with scoliosis and disk herniation…all things that go with aging. I also have reflux disease with esophageal spasm, for which I take pantoprazole. For the last several years I’ve gotten by with taking 1 200 mg. ibuprofen daily for body pain. Several months ago the esophageal spasm got so bad I had to start on the pantoprazole. Now it’s to the point that I can’t find any NSAID that doesn’t increase that painful spasm. The problem is, without the ibuprofen I can’t do much more than walk around the house, and even that’s very painful. I normally walk at least a mile a day at a good clip, and need that exercise for my osteoarthritis. I’ve tried many prescription antiinflammatories, and they all aggravate the reflux problem. Is there any solution here?
Congratulations on your commitment to exercise and I’m sorry to hear about your difficulties.
As a Geriatrician, we do try to avoid using NSAIDs over the long term, as Dr. Kernisan mentions, but the alternatives to them are not always other drugs. Osteoarthritis management can include things like weight loss, exercise, physiotherapy, meditation, and massage. Some people need surgery, or to use a gait aid or device to off load the painful joint.
Similarly, there can be dietary and other strategies to reduce the risk of esophageal reflux and spasm. A nutritionist might be able to offer advice.
I would advise someone in your shoes to not give up, and think about non-drug strategies in order to avoid more medication side effects.
Hi Dr Nicole, great insights as I read these threads. Am from the Philippines and currently suffering from back pain due to a bad fall. After self medicating with Mefenamic to Salonpas patches, it quite improves but the pain still there in my left back side. My doctor prescribed Arcoxia plus Lagaflex for 7 days but still there is pain. He switches Mobic and Myonal but pain still lingers. Patches works but momentarily only. I notice air fills my stomach which makes me fart. Am 65 yrs old and haven’t talked to my doctor yet that his medications isn’t working. Any comments? Thank you.
I’m so glad that you find the discussion helpful!
I’m sorry to hear about your fall and your pain. I’m not familiar with many of the drugs that you mention, but it sounds like they are all common classes of meds that are used to treat musculoskeletal pain: NSAID,s, topical patches (which can contain methyl-salicylate or lidocaine), COX-2 inhibitors (like NSAIDs but less likely to bother the stomach), muscle relaxants, and ant-spasmodics. Each of these classes of medications can cause side effects, like stomach irritation, constipation, bloating, sleepiness and others (including flatulence!). When trying out different meds to treat pain (or any symptom, really), it’s important to keep careful track of whether the dosages and timing of the meds need to be optimized before trying something else. It can be tempting to give up after a few doses if it seems like it’s not working.
Along with the medications that you mention, non-medication strategies are usually recommended to help with acute back pain (like pain from an injury or fall). This can involve exercise, massage, heat and cold packs, and physiotherapy. And for some, other investigations can sometimes be needed, like an X-ray or ultrasound.
For most individuals with acute back pain, it is fully resolved by about 7 weeks, which can feel like a long time, especially when a person is suffering.
The other thing to look at is why a person is falling, and there’s a good article about that, which you can read here.
I am a female 83 1/2 years old. Have been dealing with osteoarthritis of both knees but still working in yard doing more than I should in a not level lawn. My knees have got so bad swollen like elephant legs and so painful could not walk on right knee a few days. My surgeon doctor has scheduled TKR on right knee for September 8, 2020 which is very soon. He thinks a epidural would serve me better because of my age. I have osteoporosis in back for years not a problem so far and I have a horror of a needle in my spine or nerves. The same doctor did a complete hip replacement in 2015 with anesthesia with absolutely no problems. I did have C-dif after going home but had stayed in a bad rest home a few days was probable cause. Had no problem with hip and only used ice and low doses of tylenol. What is your thoughts on this? I am frightened of a needle in back since I have no back problems and I find this does have serious side effects later after use.
Thank you if you have time to email me. I receive your post and your inputs mean a lot for me. Thanks for your service. Mary
I can understand being nervous about an upcoming surgery. As far as a I know, osteoporosis is not a reason to avoid a spinal anesthetic, but if you have a major spinal deformity, like spina bifida or have had back surgery before, you should let your doctor know.
Of course, no medical procedure is without risks, but the risk of nerve damage is extremely low, about 1.6 per 100,000 procedures. There can also be advantages to having spinal anesthesia instead of general, which can include better pain control and lower risk of lung-related complications. Here’s a video about the spinal anesthetic for knee surgery made by a couple of orthopedic surgeons (WARNING- it does include film of an actual spinal anesthetic being performed).
If you have a specific fear about the procedure, let your doctor know what exactly you’re most worried about. Your doctor might be able to provide you with information that will help you decide if it’s right for you, and what alternatives you have available. Good luck with your surgery!
I’m a 66-yr.-old male who recently suffered an eye
stroke and am having a hard time with statin medications.
My cardiologist has tried two different ones, the first being Lipitor (35 mg) which caused much muscle and joint pain. After a month,
he then put me on Crestor (5 mg) which had the same effect making my whole body sore and weak.
He said I need some type of statin to prevent another stroke. he did, though, take me
off statins after a month on Crestor, for two weeks and wants to slowly reintroduce Crestor starting twice a week.
I’ve been very healthy person all my life, with low blood pressure and low cholesterol levels. Exercise has always been a daily regimen and have no weight issues.
I guess my question to you is what are the chances this (stroke) could happen to me again, especially if I chose to stop taking a
Statin medication, which really does raise havoc with my muscles and joints. Can you recommend a non-statin alternative?
I’m taking Tylenol (650 mg) daily to ease the discomfort. I had been
relying on ibuprofen until I came across your health columns.
Thank you for your “healthy” advice!
I’m not sure exactly what you mean by “eye stroke” but, in general, after a stroke, taking a statin to lower the LDL-cholesterol can reduce the risk of having another stroke by about 2-5%., according to a recent meta-analysis (a systematic review of the existing literature about statins and stroke).
The other strategies that you mentioned can be helpful to reduce stroke risk as well (weight management, blood pressure control, exercise, and of course not smoking).
For those who can’t take a statin, there’s a medication called ezetimibe which can also lower risk of stroke and can be taken with or without a statin.
Thanks for letting us know about using tylenol in place of ibuprofen! This is a healthier choice for most older adults!
I’m sorry, i should have been more specific in regards to my mentioning the eye stroke I suffered in July of this year. It ‘s known as Retinal Artery Occlusion, which caused severe loss of vision.
I dislocated my left shoulder 3 years ago. They put it back in place however there are 3major torn tendons with massive tears. Injections are not for me do to the risk that all involved and surgery is not an option because they cannot repair torn tendons. I have chronic pain. I’ve had a EMG and there isn’t any signs of nerve damage. It’s the torn tendons that are killing me. I cannot sleep due to my condition and Aleve and OTC medicines are useless. I’ve tryed all kinds of creams that promise pain relief to no avail. Any suggestions?
I’m so sorry to hear about your shoulder injury. If I was seeing someone in your situation, I would recommend physical therapy that focuses on stabilizing and strengthening the shoulder and then getting the function back. A physical therapist might be able to suggest a brace or something that could help at nighttime.
My doctor wants to put me on celecoxib for
rheumatoid arthritis and osteoarthritis but I am afraid to take this medication because of all of the side effects. I am 67 years old, I also have diverticulitis and this medicine is supposed to also cause stomach issues.
Celecoxib is a COX-2 inhibitor, similar to an NSAID (like ibuprofen) but less likely to cause stomach and small intestine irritation and bleeding, but as far as I know it does not affect diverticulosis (which usually affects the colon or large intestine) in any way.
I am.63 years old male having muscular pain of left side lower ribs. I am taking Panadol Extend 2 tabs 1330 mg 2-3:times a day but not much relief. I added M Myonal 50 mg to it but no relief.
I cannot take Ibuprofen, Diclofenac because they raise my BP.
Or should I take Aspirin?
Aspirin (or ASA) is considered an NSAID, just like ibuprofen, so it may not be right for you if you avoid drugs like ibuprofen. With ASA at any dose, the main side effect we worry about is gastrointestinal irritation and bleeding.
Thank you so much for the most informative articles.
I am allergic to aspirin. Is there an alternative drug for persons like me especially when we often hear that aspirin can save lives in the event of a stroke?
I’m so glad you found the article helpful!
If a person has an ASA (acetylsalicylic acid, which is the chemical name for aspirin), then there are options. Most commonly, if a person is at risk of stroke, we use clopidogrel . This medication is similar to aspirin in that it affects platelets and makes the blood less likely to clot, so bleeding can be a side effect. Clopidogrel is only available by prescription.
Many insulin dependent diabetics use a CGM (continuous glucose monitor) in conjunction with their insulin pumps. One manufacturer whose previous model came with the caution that acetamenaphrin would cause inacurate readings supposedly corrected that problem in its latest model. However, if I take 500 mg of Tylenol it causes significant reading errors or even sensor failure after about 4 hours. I need something at night to add to my regular non-chemical pain relief routine and my cold packs. Can you suggest something? Dr. suggested OTC lidocaine patches but they are not effective for me. Thank you for your work.
Hi Linda and thanks for sharing your story.
I didn’t know about the effect of acetaminophen on CGM’s, so I’m not sure what to suggest. Depending a person’s age and other medical issues, aspirin might be reasonable, and I’ve used duloxetine for pain in those with diabetes and nerve-related pain. Duloxetine is an anti-depressant but does have pain relieving properties too.
I hope you find a solution!
Thank you for an informative article. The warnings about not using aspirin as an analgesic and the PM” versions of OTC meds. I read some of it to my wife and she responded with an, “Oh oh!” A half hour later she came out with an amazing assortment of “PM” bottles to be disposed of.
Appreciate the help in “spring-cleaning” our medicine cabinets
Hooray! Good job cleaning out the medicine cupboard. Thanks for sharing your success story with us and for reading the article!
My daughter almost died from an accidental overdose of a drug that added Tylenol to another pain medication. She went into total liver failure and barely survived. The pharmaceutical company’s choice to add Tylenol was simply to make the other drug patentable and increase the pharmaceutical company’s profit. This is immoral, should be illegal and was almost lethal.
I’m so sorry to hear about your daughter’s experience and I’m glad she recovered.
Acetaminophen (also called paracetamol, brand name Tylenol) is used by many older adults for pain from arthritis, but it’s important to be mindful of the maximum daily dose. Most Geriatricians I know suggest keeping the dose at less than 3000 mg a day. Here’s an article that might be helpful: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509082/
This is completely crazy. Tylenol is useless. I have never had Tylenol to prove to reduce anything. Thus far for me, only powdered aspirin with milk is the only thing that helps to continue to buffer pain with the inclusion of Norco and Morphine which I take daily for severe pain. I have been using this combination for years. So far I have been kept comfortable. The aspirin is not required on a daily basis, maybe once or twice a week.
My wife has been suffering from severe pain and Dr. will not provide any medication beyond Tylenol which is useless to her. I coaxed her into aspirin which gave her far more relief than Tylenol does but the pain has been really miserable and makes it very hard for me also, watching her suffer in this manner. A simple prescription for her during this period would be at the least a Tylenol 3 but Dr will not even prescribe this.
All doctors seem to be terrified of the DEA if they make even one or two prescriptions. I have been fortunate to have a doctor who is not terrified of the DEA over his prescriptions for me and others like me. Our pain is well documented. My wife is alternating Aleve, Advil, aspirin. I am hoping that soon she will be able to remove all of these as with the passing days the pain is showing some signs of abating as she uses also Lidocaine patches and creams and now a product of Voltran.
Thanks for taking the time to comment and share your experience and that of your wife. I’m sorry that it’s been so difficult to get relief from your pain.
In my practice in Canada, I certainly use narcotics when needed, but I try to use the a smaller dose and monitor carefully. We also use narcotics in conjunction with other non-narcotic treatments when we can. Pain management is complex and often needs a team, which unfortunately can be hard to access.
If a person’s family doctor isn’t comfortable prescribing narcotics, they might be open to a referral to a pain clinic that they can collaborate with for expert guidance.
I’m glad to hear that the topical medications (patch and creams) are effective and I hope you get the help you need soon.
Great article! You provided a thorough explanation of the nsaid/painkiller subject matter. Thank you.
I’m so glad you enjoyed the article! Let us know what other topics you’d like to see covered.
IL am a 75 y.o. man. November of 2013, I was invaded by e-coli bacteria. After studying me, 2 different neurologist agreed, that the e-coli had left the small intestine and invaded the spinal nerve sack. Around the D-4 or D-5. One of the problem I have, is that I have upper body jerks. At night I take a 300mg Gabepentin, a 50/200 carbidopa/levodopa and a 650mg. Tylenol. I normally get 5 hours of sleep, before the jerking starts again. However, I was told to stop taking the Tylenol after 10 days and then start again after 30 days. It seems C&L pill stopped working a couple of years ago. My PCP is to busy to study the problem and won’t give other neurologists a referral, saying more study isn’t needed. My question to you. What chemical or herbal medicine would help me? Thank you so much!
It sounds like you’re describing myoclonus, which can occur after a severe neurological infection. The treatment is usually with an anti-seizure medication (like gabapentin) or a sedative-hypnotic like clonazepam for example. I’m not sure where the Tylenol fits in, unless that’s related to some nighttime pain.
If your regimen has stopped working for you then it’s important to review whether something else has changed in your life: medications, habits, or another medical issue. I didn’t find anything about herbal remedies for myoclonus in my quick literature review, and I would really suggest talking to a doctor who knows your whole story to figure out the next steps.
It’s absolutely outrageous that this doctor is advocating the use of tylenol for pain relief . much research has proven that it works no better than placebo for pain relief…. and it is very bad on the liver. i wonder why she would then prescribe it for elderly patients. why she would prescribe it for anyone. but especially elderly who are less likely to complain. i am not among them. i complained . i did the research. acetaminophen….. tylenol whatever it’s called … anywhere in the world … is the biggest con job in american medicine. i have polyarticular bone to bone osteoarthritis so bad i was prescribed the morphine pain patch. i couldnt use it because it made me cry .. nonstop. im still searching for relief i might have to chose between the side effects of celebrex or mobic… but with either i get some pain relief. its my body. my quality of life . i have not one moment or movement free of pain. and i have my share of horror stories about the state of medical care in this country. for years my progressing arthritis went undiagnosed because no one would order xrays. it was easier for them to tell me i had … fibromyalgia. yeah. i’ll stop there . oh wait yes i know fibromyalgis is real.. to them… but there is no damage to the body. zip. its mostly mental. and all poor women, whatever our color are chronic malingerers. i didnt get a series of xrays until i was .. 60 years old.its… everywhere. it hurt to type this. . ive also used aspirin , ibuprofen, naproxen, and given tramodol until i realized it is a narcotic. every single one of them provided some measure of relief. but tylenol was worthless.i expect it will take another 10 years until that is common knowledge to drs. and even then, well, i wont hold my breath. they don’t like admitting mistakes.
Hi Valerie and thanks for sharing your experience. I’m sorry that you’ve had a difficult time getting effective help for your osteoarthritis, and that you haven’t felt heard by your providers.
You’re correct that acetaminophen seems to be pretty ineffective for hip and knee OA, as based on this systematic review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388567/, but there is a small effect, and the side effects are few for most people. Thus, in many pain management guidelines, acetaminophen is the first line of treatment. The critical thing is to evaluate if the acetaminophen is working and try something else, after discussing it with the patient.
As you point out, there are many side effects and risks with narcotics as well. OA management should best be holistic, but getting access to all of the non-medication treatments that would help is not easy.
Unfortunately my wife and I have always found paracetamol to be completely useless as a painkiller. We don’t reach for aspirin because it is what we’re used to, but because it actually works where paracetamol does nothing at all. In my case it has never worked. It was what my parents gave me as a child, because of potential risks associated with aspirin in children, but it never did anything. It was only as an adult that I realised what pain relief actually was because I switched to the alternatives.
This all makes things quite tricky. Opioids are addictive, NSAIDS are bad for the stomach and intestines and paracetamol is ineffective.
Many patients of mine, and the scientific literature, would agree that paracetamol (acetaminophen) is not very effective for arthritis pain for most people. You’re right about the hazards of opioids and NSAIDs as well.
Other medication alternatives include COX-2 inhibitors (like meloxicam for example), which have a lower GI bleeding risk than NSAIDs, and some antidepressants or ant seizure medications like duloxetine or pregabalin. This article from the Mayo clinic does a good review of some pain mediations: https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371
The other part of pain management is non-medication strategies like exercise, weight management, mindfulness, stress reduction and physiotherapy and other professional input.
Can pain meds like Aleve raise potassium levels?
NSAIDs like Aleve and Advil can interfere with the synthesis of prostaglandin and this can raise potassium levels. It’s more likely to happen if someone is also living with kidney impairment, dehydration or heart failure. I found an article that explains this here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894511/
I’m 66 with heart failure that hasn’t progressed, cirrhosis from fatty liver and T2. I also have psoriasis and psoriatic arthritis. All of that said, I do have inflammatory flare ups but usually can handle the discomfort. About half a dozen times a year if I have a flu or something that causes aches and fever, I will take an inpuprofin or naproxen once or twice at 200mg but avoid acetaminophen because of my liver. Does this infrequent usage carry much risk?
I’m not sure what “T2” refers to (maybe taking Tylenol #2?), but thanks for describing your other health issues.
The potential issue with taking an NSAID like ibuprofen or naproxen with conditions like cirrhosis and heart failure, is the fluid retnetion and kidney strain that those medicaitons can cause. A higher dose and longer duration of use is more risky than if you only take a few doses a month, but it’s best completely avoided.
Talking to your doctor or pharmacist could help you decide if the trade off of risk vs benefit is worth it for you.
Can meloxicam cause memory lose. I realize it’s an nsaid, I take it intermittently for a painful hip. I heard it is not effective if it’s not taken daily, any truth to that?
It does help allot with my hip pain. I’ve tried several different shots in the(GTB), dry needling and months of physical therapy. It keeps coming back, worse at night while sleeping.
If I take mobic as needed will it work or do I have to take on a regular basis?
Thank you!
Mobicox (meloxicam) is a newer NSAID that acts on the COX-2 enzyme and seems to be less likely to cause gastrointestinal bleeding, although it still can. We generally avoid them for long term use on older adults, because they can affect the kidneys, worsen heart failure and edema, and increase bleeding risk.
Meloxicam can work if taken occasionally, or for a few days or weeks at a time, but some need to take them every day long term. It’s good to use other methods like physiotherapy, exercise and topical or injectable treatments to spare the meloxicam use.
In terms of memory loss, meloxicam has actually been studied in rats to see if it can reduce brain inflammation and be protective of neurons, but we don’t have enough information to recommend it for that use in humans.
I’m an old person, how can I alleviate the pain I have? I have been diagnosed with inflammation of my ribs, the cartilage is swollen and very painful. ( Costochondritis)
Costochondritis is inflammation of the cartilage in the joints where your ribs meet your breastbone. It is painful and can be caused by trauma (being hit in the chest) or excessive coughing.
Treatment can start with a warm compress and stretches. Medications that can be helpful include pain-relieving creams (containing capsaicin, NSAIDs or numbing medication), or oral pain meds like acetaminophen or ibuprofen. We use ibuprofen and other NSAIDs with caution in older adults, as they can affect kidneys and blood pressure, and increase the risk of stomach irritation and bleeding.
It can take up to a few weeks for the pain of costochondritis to subside. If it gets worse or is accompanied by pother symptoms like shortness of breath, cough, fever or coughing blood, I would advise seeking medical attention right away.
I have been diagnosed with spinal stenosis, levoscolois ( spelling?) And schmorols nodes and a few other things. I was referred for spine injections, but the Dr couldn’t get the needle between my vertebrates. She wanted to prescribe opioids, but I declined. I have nine years of sobriety from alcohol and I in no way want to chance going through addiction again. I have no diseases of any organ. What in your medical opinion would be the best OTC option for me. I’m 36 year’s old and male. 5’9″ thank you again. God bless and best wishes.
Congratulations on your sobriety and sorry to hear about your back pain.
I don’t treat younger or middle-aged adults in my practice, and I can’t give specific medical advice over the internet, sorry.
For my older patients with chronic pain, I usually suggest acetaminophen as the safest OTC, as Dr K mentions in the article. For some older adults, short term use of NSAIDs (like ibuprofen) or COX-2 inhibitors (like meloxicam) can be considered. COX-2 inhibitors are by prescription. NSAIDs (and COX-2’s) need to be used with caution in those with kidney impairment, bleeding risks (like an active stomach ulcer), or edema.
Your pharmacist would be a good professional to talk to about OTC pain medications. Best of luck!