Caring for a parent with chronic pain What's actually happening, and how you can help

Caring for a parent with chronic pain means managing two opposite problems: pain that goes undertreated because older adults minimize it, and medications that carry genuine risks in elderly patients. The caregiver's most important job is accurate reporting, not deciding whether the pain is real.

Most families land in one of two places with this. There is the parent who mentions pain at every visit, every phone call, and every transition between rooms. The family quietly wonders whether it is as severe as described. And then there is the opposite: the parent who never complains, who says "I'm fine" through gritted teeth, who does not want to be a bother. Both of these are real problems. Both of them lead to worse outcomes.

The thing that makes chronic pain in elderly patients genuinely complicated is that these two problems exist at the same time. Pain is routinely undertreated in older adults, and the medications that treat it carry risks that are more serious in elderly patients than in younger ones. Understanding both sides of that is the foundation of being an effective caregiver.

Why chronic pain is undertreated in older adults

According to the American Geriatrics Society, chronic pain affects roughly half of community-dwelling older adults and up to 80 percent of nursing home residents. Despite how common it is, it is consistently undertreated.

Part of the problem comes from the patient. Older adults who grew up in a different era often frame pain in terms of endurance. "I don't want to make a fuss." "It's not that bad." "Others have it worse." They may underreport pain to avoid burdening family, or because they genuinely believe some amount of pain is just part of getting old. Some have been told as much by providers who said things like "well, what do you expect at your age?"

Part of the problem also comes from providers. Some clinicians are reluctant to prescribe adequate pain control for older patients because of legitimate concerns about medication risks or addiction potential. The result is that pain that could be better managed often is not.

What undertreated pain actually does

Chronic pain is not just uncomfortable. In older adults, poorly managed pain is associated with depression, disrupted sleep, reduced mobility, social withdrawal, and cognitive decline. Each of those outcomes makes the pain harder to manage and the person harder to reach. A parent who stops moving because of pain loses muscle strength and balance. A parent who cannot sleep because of pain becomes more cognitively impaired and more emotionally reactive. The cascade moves fast.

This is why the connection between chronic pain and depression is worth keeping in mind. If your parent's mood has worsened alongside their pain, that is not a coincidence and it is not simply a personality change. For more on recognizing depression in aging parents, see When a Parent Becomes Depressed: Recognizing It and Responding.

Why medication risks are different for elderly patients

The same body of research that shows pain is undertreated also shows that the most commonly used pain medications carry real risks in older adults. This is not an argument against treating pain. It is an argument for treating it carefully.

NSAIDs: more risk than most families realize

NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). They are effective for pain and inflammation, and they are widely available without a prescription. In younger adults, they are generally safe for short-term use. In older adults, the risk profile looks different.

The American Geriatrics Society recommends avoiding NSAIDs in most older adults because of their association with GI bleeding, kidney damage, fluid retention, and increased cardiovascular risk. These risks increase with age, increase with regular use, and increase when the patient is already taking blood thinners, diuretics, or ACE inhibitors. If your parent is taking an over-the-counter NSAID regularly, it is worth flagging with their doctor.

Acetaminophen: safer, but not without limits

Acetaminophen (Tylenol) is generally the safer first-line choice for musculoskeletal pain in older adults. It avoids the GI and kidney risks of NSAIDs. The concern with acetaminophen is its narrow therapeutic window. The maximum safe dose for most adults is 3,000-4,000 mg per day. Older adults, patients who drink alcohol regularly, and patients with liver conditions are at higher risk of toxicity even within that range.

The other issue is that acetaminophen is hidden inside many combination products (cold medicines, sleep aids, prescription opioid combinations like Vicodin). It is easy to take more than intended without realizing it.

Opioids: specific risks in older adults

Opioids are appropriate for some older adults with moderate to severe pain, particularly cancer-related pain. But their risk profile changes with age. Older adults are more sensitive to opioid effects, which increases fall risk and risk of altered mental status. Constipation is a consistent side effect and can become a serious problem when it goes unmanaged. Starting doses for opioids in elderly patients are typically lower than in younger patients for these reasons.

None of this means opioids should be withheld from older adults who need them. It means they require more careful monitoring and more proactive management of side effects.

Common sources of chronic pain in older adults

Knowing what is causing the pain helps frame what kinds of treatment are likely to help.

• Arthritis (osteoarthritis and rheumatoid): The most common source of chronic pain in older adults. Osteoarthritis involves joint cartilage breakdown, most often in knees, hips, and hands. Rheumatoid arthritis is an autoimmune condition requiring different treatment.
• Neuropathic pain: Nerve pain from diabetic neuropathy (burning, tingling, numbness in feet and legs) or post-herpetic neuralgia (persistent pain after a shingles rash). These pain types often respond poorly to standard analgesics and may require specific medications.
• Back pain: Spinal stenosis (narrowing of the spinal canal) and degenerative disc disease are common in older adults and can cause persistent low back or leg pain.
• Cancer-related pain: May arise from the tumor itself, from cancer treatment side effects, or from related conditions. Pain management is a central part of oncology and palliative care.

The caregiver as reporter, not judge

Pain is subjective. There is no blood test for it. Two people with identical X-rays can have completely different pain experiences. This makes pain assessment difficult, and it creates a trap for caregivers who start trying to evaluate whether the pain is "real" or "appropriate."

That is not your job. Your job is to accurately report what you observe to the care team: how your parent describes the pain, what it prevents them from doing, how it affects their sleep and mood, what makes it better or worse. The 0-10 pain scale is imperfect, especially for older adults who tend to underreport. Behavioral observation is often more reliable: are they moving differently? Guarding a particular area? Getting up from a chair with more difficulty? Not sleeping?

For cognitively impaired patients, behavioral pain assessment tools exist (such as the PAINAD scale) that do not rely on self-report. If your parent has dementia and seems to be in pain, ask the care team about behavioral assessment approaches.

The flip side is also worth naming. If you are caring for a parent whose pain complaints feel out of proportion to what you can see, the honest response is still accurate reporting, not skepticism. Pain amplification is a real phenomenon, often connected to depression, anxiety, or poor sleep. The treatment for that is not dismissal; it is comprehensive assessment.

Non-pharmacological approaches with real evidence

Non-drug approaches to pain management are not a consolation prize for patients who cannot tolerate medication. Several have solid evidence behind them, and some work better for specific pain types than medication does.

Physical therapy and exercise

This one consistently surprises families. The instinct when someone is in pain is to rest and protect the area. For arthritis and back pain, the evidence points the other direction. Gentle, guided exercise reduces pain and improves function in older adults with osteoarthritis. Physical therapists can design programs that are appropriate for an older adult's fitness level, and can address fear of movement, which is a real barrier for many patients.

Heat and cold therapy

Heat (warm compresses, heating pads set on low) relaxes muscles and increases blood flow, useful for chronic muscle tension and arthritis stiffness. Cold (ice packs wrapped in cloth) reduces inflammation and numbs acute pain. Neither approach replaces medical treatment but both are low-risk and can meaningfully reduce moment-to-moment pain burden.

TENS (transcutaneous electrical nerve stimulation)

TENS units deliver small electrical pulses through electrode pads placed on the skin near the pain site. The mechanism is not fully understood, but research supports their use for musculoskeletal pain, including arthritis and back pain. Units are available without prescription. A physical therapist or pain specialist can advise on placement and settings.

Cognitive behavioral therapy for chronic pain

Chronic pain has a psychological component that is real and bidirectional. Anxiety, depression, and poor sleep all amplify pain perception. CBT for chronic pain does not tell patients the pain is not real. It addresses the thought patterns and behaviors that worsen pain intensity and interference with daily life. Research supports its effectiveness, including in older adults. It can be delivered in person, in group settings, or digitally.

Sleep management

Poor sleep worsens pain sensitivity. This is physiological, not willpower. Addressing sleep hygiene, treating sleep disorders, and managing pain specifically at night (sometimes with different medication strategies for nighttime than daytime) can reduce overall pain burden meaningfully.

Working with the care team

If your parent's pain is not well-controlled on their current regimen, that is a reason to escalate, not to accept. Ask directly: "Is there a pain management specialist we should see?" or "Would a palliative care referral make sense here?"

Palliative care is not synonymous with end-of-life care. Palliative care teams are specialists in symptom management, including pain, and they work alongside primary care and specialty teams at any stage of illness. A palliative care consultation is appropriate any time a patient has pain that is not adequately controlled, regardless of diagnosis or prognosis. Many families do not know they can ask for this.

Pain management specialists (anesthesiologists or physiatrists with pain subspecialty training) are another option, particularly for complex or refractory pain. Interventional pain procedures such as nerve blocks or spinal injections are sometimes appropriate for specific pain types.

When attending appointments, bring a written summary: where the pain is, when it started or worsened, what makes it better or worse, how it affects daily activity and sleep, what has been tried, and whether current medications are working. Providers see many patients. Written information is more reliable than trying to reconstruct details in the room.

For a broader overview of health conditions affecting aging parents, the health conditions hub covers the full range of conditions caregivers commonly navigate.