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

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Caring for a parent with chronic pain means two things at once: the pain is often undertreated, and the medications that treat it carry risks with age. The caregiver's 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 brings up pain at every visit, every phone call, every transition between rooms, until the family starts to wonder how much of it is real. And there is the opposite parent, the one who says "I'm fine" through gritted teeth and would sooner grind through a bad hip than ask for help. Both patterns lead to worse outcomes. Both are common enough that neither one, on its own, tells you anything about whether the pain is being handled well.

What makes chronic pain in older adults especially hard is that these two problems sit on top of each other. The pain itself is routinely undertreated; federal health survey data puts it in roughly 3 in 10 adults age 65 and older. The drugs used to treat it carry risks that grow, not shrink, with age, and a caregiver who understands both sides of that is already ahead of where most families start.

Why chronic pain in older adults goes unmanaged

Chronic pain is not rare in later life. The same CDC survey also found high-impact chronic pain, severe enough to limit daily life or work, in about 12 percent of adults age 65 and older. Despite how common it is, pain in older adults is consistently undertreated. The reasons sit on both sides of the exam room.

Part of it comes from the patient. Older adults who grew up in a different era often treat pain as something to endure, not something to report. "I don't want to make a fuss." "It's not that bad." "Others have it worse." Some simply believe pain is just part of getting old, sometimes because a provider implied as much years earlier.

Part of it comes from providers, who are sometimes reluctant to prescribe or intensify pain treatment for older patients out of legitimate concern about medication risk. That caution has a real basis. The problem is that it can leave real, undertreated pain unaddressed for months or years.

What Undertreated Pain Actually Costs

Chronic pain is not just uncomfortable. MedlinePlus notes it can bring fatigue, mood changes, and difficulty sleeping, and that depression or stress can make the pain itself worse in turn. A parent who stops moving because of pain loses muscle strength and balance, while a parent who cannot sleep because of pain becomes more reactive and harder to reach the next day. The two feed each other.

This is worth keeping in mind if your parent's mood has shifted alongside their pain. A mood change like that is neither a coincidence nor a simple personality shift. For more on recognizing depression in an aging parent, see When a Parent Becomes Depressed: Recognizing It and Responding.

The medications carry real risk at this age

The same evidence that shows pain is undertreated in older adults also shows that the drugs most often used to treat it need to be handled with more care at this age. That is the case for treating pain deliberately, at every step.

NSAIDs: Where the Guidance Is Clearest

NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). They work well for pain tied to inflammation and are sold without a prescription. In a younger adult, short-term use is generally low-risk. In an older adult, the calculation changes. The American Geriatrics Society's 2023 Beers Criteria, its physician-facing list of medications that carry outsized risk in older adults, recommends avoiding oral NSAIDs in most people in this age group. HealthInAging.org, the Society's own public-facing arm, explains that the list flags medications whose risks may outweigh their benefits for older adults, not medications that are automatically off-limits. Its stated reasoning: upper GI ulcers, bleeding, or perforation occur in 1 percent of patients treated for 3 to 6 months, and in 2 to 4 percent of patients treated for a year. NSAIDs can also raise blood pressure, and the risk of kidney injury rises with dose. If your parent takes an over-the-counter NSAID on a regular basis, that is worth raising with their doctor rather than assuming it is harmless because no prescription was needed.

Acetaminophen: Safer, Not Risk-Free

Acetaminophen (Tylenol) is a common first choice for musculoskeletal pain in older adults, in part because it avoids the GI and kidney risks tied to NSAIDs. MedlinePlus, the National Library of Medicine's consumer health site, describes it as "often considered safer than other pain relievers." It also warns that "it's common for people to take too much accidentally," and advises checking with a provider before using acetaminophen-containing medicines for more than ten days. Part of the risk is that MedlinePlus describes acetaminophen as used in many other OTC and prescription medicines, not just standalone pain relievers. A parent can end up taking more of it than anyone realizes, without ever exceeding a single product's own instructions. A pharmacist can check a parent's full medication list for acetaminophen overlap in a few minutes.

Opioids: A Narrower Margin

Opioids are appropriate for some older adults with moderate to severe pain, cancer pain in particular, but their risk profile shifts with age. The Beers Criteria list opioids among the drug classes tied to a higher risk of falls and fractures in older adults. They also note an association between opioid use and delirium, which can show up as sudden confusion instead of obvious sedation. If a parent on an opioid becomes suddenly more confused, treat that as a medication question, not just a memory question, and see Sudden Confusion in an Elderly Parent for what else can cause it. MedlinePlus also lists drowsiness, mental fog, and constipation among the more routine side effects, but none of this means opioids should be withheld from an older adult who actually needs them. It means the monitoring has to be more active than it would be for a younger patient.

What is actually causing the pain

Knowing the likely source helps frame what kind of treatment is worth pursuing first.

• Arthritis (osteoarthritis and rheumatoid): the most common source of chronic pain in older adults. Osteoarthritis is cartilage breakdown, usually in the knees, hips, or hands; rheumatoid arthritis is an autoimmune condition that is treated differently. MedlinePlus notes there is no cure for osteoarthritis, but treatment "usually begins with" exercise, weight loss where relevant, and supportive devices such as braces.
• Neuropathic pain: nerve pain from diabetic neuropathy, where MedlinePlus lists numbness and shooting, burning, or tingling pain in the hands, legs, or feet as common symptoms. Or postherpetic neuralgia after shingles, "the most common complication of shingles," per MedlinePlus. It often responds poorly to standard pain relievers and may need a different class of medication; for more on the diabetes side of this, see Managing Diabetes in an Elderly Parent.
• Back pain: spinal stenosis, narrowing that puts pressure on the nerves and spinal cord, is common after age 50 and can cause pain in the neck, back, or down a leg.
• Cancer-related pain: per the National Cancer Institute, can come from a tumor itself, treatment, or diagnostic procedures. Options beyond drugs include nerve blocks, described there as injecting an anesthetic or other drug into or around a nerve to block pain. Pain control is a core, not secondary, part of oncology and palliative care.

Is it your job to decide whether the pain is real?

No. Pain is subjective, and there is no blood test for it. MedlinePlus puts it plainly: "Each person feels pain differently, even if the reason for the pain is the same." That is what makes pain assessment hard. It is what tempts caregivers into silently auditing whether a parent's pain is "as bad as they say."

Your job is narrower than that. Report what you observe to the care team: how your parent describes the pain, what it stops them from doing, how it affects sleep and mood, what makes it better or worse. Where a parent tends to downplay pain, behavioral observation often carries more information than a self-rated number: is your parent moving differently, guarding a particular area, taking longer to get up from a chair, sleeping worse than usual?

For a parent with dementia who cannot reliably self-report, behavioral pain-assessment tools exist that do not depend on the person describing their own pain. The Pain Assessment in Advanced Dementia scale, known as PAINAD, is one such instrument used in dementia care research and practice. Ask the care team whether a behavioral tool like it is being used, if your parent has dementia and seems to be in pain.

Most of the time, trusting a parent's own account of their pain is the right instinct. There is a real, if less discussed, flip side: some caregivers are managing a parent whose pain complaints seem out of proportion to anything visible on an exam or a scan. The honest response there is still accurate reporting, not skepticism. As MedlinePlus puts it elsewhere, depression or stress can make pain itself worse, so a fuller assessment is the fix, not a decision that the pain "isn't real."

Non-drug options with evidence behind them

Non-drug pain management is not a fallback for patients who cannot tolerate medication. Several approaches have real evidence behind them. For some pain types, they outperform what medication alone can offer.

Physical Therapy and Exercise

This one consistently surprises families. The instinct when someone is in pain is to protect the area and rest it. For arthritis specifically, MedlinePlus lists exercises to improve strength, flexibility, and balance as where treatment "usually begins," ahead of medication. A physical therapist can build a program suited to an older adult's actual fitness level, and can work through the fear of movement that keeps a lot of people from starting.

Heat, Cold, and Hands-On Care

The same MedlinePlus page lists heat and ice among the "simple things" that can help osteoarthritis pain. It adds massage, which it says "can increase blood flow and bring warmth to the area," and notes that some research shows acupuncture may help relieve osteoarthritis pain specifically. None of these replace a diagnosis, but they are low-risk and can meaningfully ease day-to-day discomfort between other treatments.

TENS Units

MedlinePlus describes TENS as a device that sends a gentle electric current to the nerves or muscles, treating pain by changing or blocking pain signals. It is delivered through pads placed on the skin near the site of pain. Units are sold without a prescription and carry little downside. How much they actually help varies by pain type and by which review of the research you read, so a physical therapist or pain specialist can advise on whether it is worth trying for your parent's specific pain.

Cognitive Behavioral Therapy

Chronic pain has a real psychological component, and it runs in both directions: anxiety, depression, and poor sleep can all make pain feel worse. The National Center for Complementary and Integrative Health, an NIH institute, reports on this directly. Studies on chronic pain found cognitive behavioral therapy and mindfulness-based interventions both helpful for decreasing pain intensity and improving physical function, with no meaningful difference between the two approaches. CBT does not tell a patient their pain is not real. It targets the thought patterns and behaviors that make pain harder to live with, and can be delivered one-on-one, in a group, or online.

Getting the care team to take it seriously

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

Palliative care is a different thing from end-of-life care. According to the National Institute on Aging, palliative care focuses on quality of life and symptom management for anyone with a serious illness. It "can start as early as a person's diagnosis," running alongside other treatment instead of replacing it. Many families never ask for it, mistakenly assuming it means giving up on treatment altogether.

A pain specialist is another option worth naming out loud, particularly for pain that has not responded to standard treatment. The National Cancer Institute (cited above) describes referral to a physiatrist, a doctor who can develop a personal pain plan and who is sometimes trained in additional procedures. A specialist referral is how most families reach that conversation.

For a broader look at the conditions that commonly bring families to this stage of caregiving, the health conditions hub covers the full range.

Bring a written summary to every appointment: where the pain is, when it started or changed, what makes it better or worse. Note how it affects sleep and daily activity, what has already been tried, and whether the current medications seem to be working. Providers see a lot of patients in a short visit, and a written note travels better than a memory does.