Pain Medicines (Analgesics) – Information for Older Adults
Plain-language information about common pain medicines in older adults. This page is for older Canadians and their caregivers. It does not replace advice from your own health-care provider.
Pain Medicines Overview
Analgesics – Medications That Relieve Pain
1. Types of common pain medicines
Pain medicines (also called analgesics) come in several types. Each works differently and has different risks and benefits, especially in older adults.
Acetaminophen
Examples: Tylenol, Atasol
Best for: Mild to moderate pain, fever
Main concern: Liver damage if too much taken
Generally safest choice for older adults when used correctly
NSAIDs
Examples: Advil (ibuprofen), Aleve (naproxen), Aspirin
Best for: Pain with inflammation (arthritis, injuries)
Main concerns: Stomach, kidneys, heart, blood pressure
Use with caution in older adults – often limited or avoided
Opioids
Examples: Codeine, morphine, oxycodone, hydromorphone
Best for: Moderate to severe pain, often short-term
Main concerns: Drowsiness, falls, confusion, constipation, dependence
Require close supervision – significant risks in older adults
Other Pain Medicines
Examples: Gabapentin, certain antidepressants, topical creams
Best for: Nerve pain, chronic pain conditions
Main concerns: Vary by medication
May be helpful for specific types of pain
The right medicine depends on you
The best pain medicine for you depends on the type of pain, your other health conditions, and what other medications you take. Always talk to your provider about which pain medicines are safest for you.
2. Acetaminophen (Tylenol, Atasol)
Acetaminophen is often the first choice for mild to moderate pain in older adults. When used within safe limits, it is generally the safest pain medicine option.
Headaches, muscle aches, joint pain, dental pain, fever
Doesn't reduce inflammation (swelling) like NSAIDs do
Most important safety rule: Don't take too much!
Too much acetaminophen can cause serious liver damage. The maximum for most adults is 3,000–4,000 mg per day – but your provider may recommend a lower limit, especially if you're older, have liver problems, or drink alcohol.
Hidden acetaminophen – watch out!
Many products contain acetaminophen, including:
- Cold and flu medicines (like Tylenol Cold, NyQuil)
- Some prescription pain medicines (like Tylenol #3, Percocet)
- Combination products for headaches, sleep, or allergies
Always check the label! It's easy to accidentally take too much if you're using multiple products. Look for "acetaminophen" or "APAP" in the ingredients.
325 mg per tablet – usually 1–2 tablets every 4–6 hours
500 mg per tablet – usually 1–2 tablets every 6–8 hours
Write down each dose to make sure you don't exceed the daily limit
3. NSAIDs (Advil, Aleve, Aspirin, and others)
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can help with pain and inflammation. However, they have important risks in older adults and are often limited or avoided.
Common NSAIDs
- Ibuprofen – Advil, Motrin
- Naproxen – Aleve, Naprosyn
- Aspirin (at higher pain-relief doses)
- Prescription NSAIDs – Celebrex (celecoxib), diclofenac, meloxicam
Important risks of NSAIDs in older adults
Irritation, ulcers, and bleeding – can happen without warning
Can worsen kidney function, especially if already reduced
Can raise blood pressure and make BP medications less effective
Can worsen swelling and heart failure
May increase risk of heart attack or stroke with long-term use
Can interact with blood thinners, BP medicines, and others
When NSAIDs might be considered:
Topical NSAIDs – a safer option?
NSAID creams or gels (like Voltaren gel/diclofenac gel) applied to the skin over a painful joint may be safer than pills for localized pain like knee or hand arthritis. Less medication gets into your system. Ask your provider if this might work for you.
4. Opioids (strong pain medicines)
Opioids are powerful pain medicines that may be needed for moderate to severe pain, but they carry significant risks, especially in older adults. They require careful supervision by a health-care provider.
Common opioids
- Codeine – often in Tylenol #3
- Tramadol – Ultram
- Morphine
- Oxycodone – Percocet (with acetaminophen), OxyNEO
- Hydromorphone – Dilaudid
- Fentanyl – patches for chronic pain
Serious risks of opioids in older adults
Can make you very sleepy and affect thinking clearly
Significantly increases fall risk – a major concern for seniors
Can slow breathing dangerously, especially at higher doses
Almost always happens – can be severe if not treated
Body can become dependent – don't stop suddenly
Can cause nausea and vomiting, especially at first
If you take opioids:
- Take exactly as prescribed – never take more or more often
- Start a bowel routine right away (stool softeners, laxatives as advised)
- Don't drive or operate machinery until you know how it affects you
- Don't mix with alcohol or other sedating medications without asking
- Don't stop suddenly if you've been taking them regularly – your provider will taper
- Store safely and dispose of unused medications properly
Opioids aren't always the answer
For many types of chronic pain (like arthritis or back pain), opioids may not be the best long-term choice. Studies show they often don't work better than other options for chronic pain and come with more risks. Ask your provider about all your options.
5. Other pain medicines
For certain types of pain, especially nerve pain (neuropathic pain), different medications may be used:
Gabapentin (Neurontin) and Pregabalin (Lyrica)
Used for nerve pain from diabetes, shingles, or other causes. Can cause drowsiness and dizziness, especially in older adults. Learn more about gabapentin →
Certain Antidepressants
Some antidepressants (like duloxetine, amitriptyline, nortriptyline) help with chronic pain and nerve pain, even if you're not depressed. They work on pain pathways in the brain.
Topical Treatments
Creams, gels, or patches applied to the skin – like lidocaine patches, capsaicin cream, or NSAID gels. May be safer because less medication enters your body.
Muscle Relaxants
Sometimes used for muscle spasms, but many are not recommended for older adults due to side effects like drowsiness, confusion, and falls.
6. General safety tips for pain medicines
Use the smallest amount that helps, for only as long as needed
Write down all pain medicines you take – prescription AND over-the-counter
Check for hidden ingredients like acetaminophen in combination products
Include all OTC products – they need the full picture
Avoid taking multiple pain medicines unless your provider approves
Alcohol increases risks of liver damage (acetaminophen) and bleeding (NSAIDs)
Medicines to be extra careful with in older adults
Some pain medicines are on lists of "potentially inappropriate medications for older adults" because their risks often outweigh benefits. These include:
- Long-term NSAIDs (especially in those with kidney, heart, or stomach problems)
- Muscle relaxants like cyclobenzaprine (Flexeril) or methocarbamol
- Meperidine (Demerol) – an opioid rarely used anymore
- Combination products with sedating antihistamines
Ask your provider if any of your medicines are on these lists.
7. Non-drug approaches to pain
Medications aren't the only way to manage pain. Many non-drug approaches can help, often with fewer side effects. Talk to your provider about which might work for you:
Ice packs for acute injuries; heat for stiff, achy muscles and joints
Staying active often helps more than resting – with guidance
A physiotherapist can teach exercises and techniques for your specific pain
Can help with muscle tension and some types of pain
Relaxation, meditation, deep breathing, and cognitive techniques
May help some people with certain types of chronic pain
Small devices that deliver mild electrical stimulation to relieve pain
Canes, braces, ergonomic tools to reduce strain on painful areas
Best approach: Combination
Often the best pain management combines medications (when needed) with non-drug approaches. This can help you use lower doses of medication while still getting good pain relief.
8. When to call your doctor, nurse practitioner, or pharmacist
(Non-urgent)
Contact your health-care provider or pharmacist if:
- You find yourself using over-the-counter pain medicines most days
- Your pain is not well controlled despite taking medication
- You have stomach pain, heartburn, or dark stools while using NSAIDs
- You are constipated, very sleepy, or confused while using opioid pain medicine
- You're not sure which pain medicine is safest for you
- You want to discuss reducing or stopping a pain medicine
- You're using multiple pain products and want to make sure it's safe
- You have new symptoms that might be related to pain medication
- You want to try non-drug approaches and need guidance
9. When to call 911 or go to the emergency department
Call 911 immediately if:
- Severe stomach pain with black, tarry, or bloody stools – could be bleeding
- Vomiting blood or material that looks like coffee grounds
- Trouble breathing or very slow breathing after taking pain medicine
- Extreme drowsiness – you or someone else cannot be woken up after taking opioids
- Confusion, agitation, or hallucinations after taking pain medicine
- Signs of severe allergic reaction – swelling of face/throat, difficulty breathing, severe rash
- Chest pain that could be heart-related
If possible, do not drive yourself. Ask someone to call for you or call an ambulance.
Naloxone (Narcan) – life-saving for opioid overdose
If you or someone you care for takes opioids, ask your pharmacist about getting a naloxone kit. Naloxone can reverse an opioid overdose and save a life. It's available free at many pharmacies in Canada.
10. Questions to ask your doctor or nurse practitioner
You can print these questions and bring them to your next appointment: