By Dr. Manoj Bhattarai, MD · Board-Certified Geriatrician · 6 min read
“My knees hurt.” “My back is killing me.” “I can’t get around like I used to.” If you’re a senior or care for one, these complaints are all too familiar. Chronic musculoskeletal pain is one of the most common reasons older adults lose their independence — and one of the most dangerous conditions to treat incorrectly.
Why Common Painkillers Are Risky for Seniors
The medications that work well for younger adults can be genuinely dangerous for people over 65. NSAIDs (ibuprofen, naproxen) can cause gastrointestinal bleeding, kidney damage, and worsen high blood pressure and heart failure. Opioids (hydrocodone, oxycodone) cause falls, confusion, constipation, and respiratory depression — and the risk of these side effects increases dramatically with age. Even muscle relaxants like cyclobenzaprine are on the Beers Criteria list of medications to avoid in older adults due to sedation and fall risk.
The Geriatric Approach to Chronic Pain
A geriatrician takes a fundamentally different approach to chronic pain in seniors. Rather than reaching for the prescription pad first, we start with a comprehensive pain assessment that considers the type and source of pain, impact on daily activities and mobility, fall risk and cognitive status, existing medications and potential interactions, and the patient’s personal goals for function and quality of life.
From there, we build a multimodal pain management plan that combines safer alternatives: optimized acetaminophen dosing (often the safest first-line option), topical analgesics applied directly to painful joints, physical therapy and gentle exercise programs, assistive devices and home modifications to reduce strain, heat and cold therapy, and coordinated specialist referrals for injections or procedures when appropriate.
Common Conditions We Manage
Knee osteoarthritis: The most common cause of chronic knee pain in seniors. We coordinate with orthopedics for injection therapies, prescribe targeted exercises, and help patients maximize mobility while protecting their joints.
Chronic low back pain: Spinal stenosis, degenerative disc disease, and compression fractures are extremely common in elderly patients. We focus on core strengthening, postural training, and safe pain relief that doesn’t increase fall risk.
Hip pain: Whether from arthritis, bursitis, or post-surgical recovery, hip pain limits mobility more than almost any other condition. Our approach emphasizes maintaining walking ability and preventing the deconditioning spiral that leads to nursing home placement.
Coming Soon: The CMS ACCESS Model MSK Track
The CMS ACCESS Model, launching July 2026, includes a dedicated Musculoskeletal Pain (MSK) track that aligns provider payments with patient outcomes — rewarding practices that help seniors reduce pain and improve function, rather than simply prescribing more medications. Florida Elder Care is a participating provider.
Don’t let chronic pain steal your independence. Contact Florida Elder Care to schedule a geriatric pain assessment, delivered at your home or facility. Learn more about our chronic pain management program.