Managing Chronic Pain in Older Adults: Strategies That Work

Chronic pain — pain that persists for three months or more — affects an estimated 50% of community-dwelling older adults and up to 80% of nursing home residents. Despite how common it is, chronic pain in seniors is frequently undertreated, partly because older adults often minimize their symptoms and partly because providers face real challenges balancing pain relief with the risks associated with many pain medications in older patients.

This guide focuses on the range of approaches available — from lifestyle changes to physical tools to medications — so that seniors and their families can have more informed conversations with their healthcare team.

Why Chronic Pain in Seniors Is Different

Several factors make pain management more complex in older adults. Many seniors take multiple medications, creating higher risks of drug interactions. Kidneys and liver process medications more slowly with age, affecting dosing. Cognitive impairment can make accurate pain reporting difficult. And chronic pain is often undertreated in older adults specifically because providers are concerned about these complexities.

This doesn’t mean seniors should accept chronic pain as inevitable. It means the approach needs to be thoughtful and often multimodal — combining several strategies rather than relying on a single solution.

Physical and Behavioral Approaches

Non-pharmacological strategies should form the foundation of chronic pain management and are often overlooked in favor of medication-first approaches:

• Physical therapy — addresses the mechanical causes of pain and builds the strength and flexibility that reduce ongoing pain.
• Exercise — counterintuitive but effective; regular low-impact movement reduces pain sensitivity over time through multiple mechanisms.
• Cognitive behavioral therapy (CBT) — proven effective for chronic pain by changing the relationship with pain rather than eliminating it.
• Heat and cold therapy — accessible, low-risk, and effective for musculoskeletal pain.

A far infrared heating pad provides deeper tissue penetration than standard electric pads and is useful for back pain, hip pain, and large joint pain. Unlike microwavable pads, electric versions maintain a consistent temperature and can be used for extended sessions — which tends to be more effective for chronic rather than acute pain.

TENS Therapy: An Underutilized Option

Transcutaneous electrical nerve stimulation (TENS) uses low-level electrical current to interfere with pain signal transmission. It’s non-invasive, has minimal side effects, and can be used at home with a portable device. Evidence quality varies by condition — it appears to work best for musculoskeletal and neuropathic pain — but many people find meaningful relief, and the risk profile is very low.

TENS units have become significantly more affordable in recent years. A portable TENS/EMS unit designed for home use can be used multiple times daily and comes with electrode pads for different body areas. Consult a physician before use if there’s a pacemaker, implanted device, or skin conditions in the treatment area.

Medication Considerations for Older Adults

When medication is needed, the general principle is to start with the lowest effective dose and avoid medications with high side-effect risk in older adults. The American Geriatrics Society maintains a “Beers Criteria” list of medications that are potentially inappropriate for older adults — it’s worth reviewing with a prescribing physician.

Topical NSAIDs (like diclofenac gel) and acetaminophen have better safety profiles for most older adults than oral NSAIDs or opioids for long-term use. Opioid medications have significant risks in older adults, including constipation, confusion, and fall risk, and are generally reserved for severe pain that hasn’t responded to other approaches.

The Importance of Pain Assessment

Chronic pain should be tracked, not just managed. A simple daily pain journal (rating pain level, noting triggers, and recording what helps) gives both the senior and their care team better information for adjusting the treatment plan over time. Patterns become visible that wouldn’t otherwise be apparent.

Conclusion

Chronic pain in older adults is common, complex, and addressable. The goal isn’t necessarily eliminating pain entirely — often that’s not realistic — but reducing it to a level that allows participation in the activities that matter most. A multimodal approach, guided by a healthcare team that takes pain seriously, produces the best outcomes.