The best pain medication for the elderly starts with acetaminophen (paracetamol) for mild-to-moderate pain due to its relative safety, but NSAIDs (like ibuprofen) can be used cautiously for short periods for inflammatory pain, while stronger options like opioids are reserved for severe cases, and topical treatments or adjuvants (like gabapentinoids/antidepressants for nerve pain) are used for specific types, always requiring careful geriatric assessment for comorbidities, kidney function, and potential drug interactions, beginning with low doses.
Good for mild, persistent pain, acetaminophen is your safest choice of the OTC pain relievers. The less-safe options are aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
Acetaminophen is generally considered safer than other pain relievers. It doesn't cause side effects such as stomach pain and bleeding. However, taking more than the recommended dose or taking acetaminophen with alcohol increases the risk of kidney damage and liver failure over time.
Morphine. Morphine and similar drugs (like oxycodone, fentanyl, buprenorphine) are the strongest painkillers. Some come in patch form, but all work in similar ways and are used for severe pain only.
The prescription pill is said to be nonaddictive. The Food and Drug Administration (FDA) recently approved a new, non-opioid prescription pill—suzetrigine. Sold under the brand name Journavx™, the drug is helpful in treating moderate-to-severe acute (short-term) pain in adults.
Over-the-counter pain medications like acetaminophen, ibuprofen or naproxen sodium, as well as topical ointments and patches can help with pain relief, but don't discount the power of movement, says Christopher. In addition to routine aerobic exercise, try gentle stretching, yoga or a muscle massage.
High risk medications
Alcohol is the drug of choice for older adults. One of the most damaging drugs to the human body, alcohols effects on physical health and cognitive functioning can be devastating to a body already facing changes in mobility and cognition as a part of the aging process.
The most powerful pain relievers are opioids, sometimes called narcotics. They include strong prescription pain relievers such as oxycodone, hydrocodone, or morphine. Opioids are sometimes used to treat moderate to severe pain.
Safer Alternatives to Tramadol
What are prescription opioids?
Commonly prescribed skeletal muscle relaxants (SMRs) are included on the AGS/Beers Criteria as Potentially Inappropriate Medications for use in older adults with musculoskeletal pain.
Buprenorphine, hydromorphone and oxycodone (including oxycodone and naloxone formulation) are the strong opioids more studied in geriatric patients[37,38,43,45]. Morphine instead should be use with extreme caution in older patients with renal impairment.
ibuprofen (Motrin, Advil, Nuprin) acetylsalicylic acid (ASA, Aspirin, salicylate) naproxen sodium (Aleve) celecoxib (Celebrex)
The relationship between examples of high medication usage, problematic maintenance, and overprescribing has not been discussed as such in the medical literature.
When chronic pain feels unbearable, focus on immediate coping (pacing, distraction, deep breathing, heat/cold) while urgently contacting your doctor or seeking urgent care for severe flares to adjust medication or get immediate relief, using techniques like mindfulness and light movement as possible, and remembering that a multi-faceted management plan with therapies (PT, psychological) is crucial for long-term control, even if there's no quick cure.
Non-steroidal anti-inflammatory drugs (NSAIDs): Oral non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen, ibuprofen, diclofenac, and celecoxib can be used for chronic pain in the elderly when acetaminophen fails to control the pain effectively.
Common causes of aging aches and pains
Arthritis: Over 50% of adults over 65 experience joint pain, with arthritis being one of the most common causes. Osteoarthritis, the wearing down of joint cartilage, is more common in older adults and often affects the knees, hips, hands and/or spine.
Acetaminophen. Acetaminophen (Tylenol) is often the first suggestion when managing chronic pain, especially for joint or muscle aches. Acetaminophen is considered one of the safest over-the-counter pain relievers when used at recommended doses, but it has limitations and hidden risks.
Chronic Pain Relief New Treatments – Journavx™ (suzetrigine)
In January 2025, the FDA approved Journavx (suzetrigine) – the first truly new class of pain medication in over 20 years. Instead of affecting your entire nervous system like opioids do, it specifically blocks Nav1.
Which Types of Pain Respond Best? Inflammatory pain from conditions like arthritis and sprains responds excellently to NSAIDs and topical anti-inflammatories. Research consistently shows NSAIDs are among the most effective first-line treatments for low back pain.