Pain, Opioids and Fall Risk

Many elders have chronic pain from musculoskeletal disorders like arthritis, from nerves damaged by diabetes or shingles, or from cancer. Consequently, more than 30 percent of people enrolled in Medicare Part D use opioid prescriptions to control pain.

What are opioids?

• Opioids (hydrocodone, morphine, oxycodone, etc.) are powerful pain relievers. They control the perception of pain and calm emotional responses to pain by reducing the number of pain signals sent by the nervous system.
• Opioids are available as pills, liquids and suckers to take orally, and as a shot, skin patch and suppository.
• Opioids are effective in relieving moderate to severe chronic pain, particularly at first. Then, as time goes on, they have less effect, and people need to take more to stop from hurting. Higher doses may work better, but higher doses also can cause more side effects.

What are the side effects of opioids?

Common side effects of opioids, which can lead to increased fall risk include:

• Confusion and depression (some individuals are misdiagnosed with dementia).
• Severe drowsiness or weakness.
• Dizziness, light headedness or feeling faint.

Elders are more at risk of side effects than younger people because elders don’t metabolize drugs as well, so drugs stay in the body longer.

Are opioids addictive?

Aside from the risk of falling, there is a risk of addiction when opioids are taken for more than a few days. While many view opioid addiction as a youth problem, many older Americans are struggling with both opioid dependency and chronic pain.

Many elders recognize the signs of growing drug dependence, but don’t talk about it. Why?

• Many individuals grew up in a time when drug addiction and alcoholism were viewed as evil, so they remain silent about the problem. They don’t want to identify as drug addicts.
• Many people aren’t aware of alternatives to opioids and fear returning to a life of constant physical and emotional pain.

For many elders, the issue becomes how to weigh relieving pain against the possibility that strong, habit-forming drugs can cause falls and lead to addiction. The good news is that nationally, opioid prescriptions have begun to decline, and some doctors have completely stopped prescribing the drugs. Many doctors are recommending nondrug alternatives to manage pain, such as exercise, acupuncture, weight loss, therapy, meditation, tai chi and yoga.

It’s important that individuals with chronic pain talk with their doctor about the benefits and risks of taking opioids, and what alternative treatments are available to manage muscle and nerve pain.