Some older people with osteoarthritis discount their pain and are reluctant to take pain relievers. A study of the use of pain medications and seniors indicates that they often have a negative attitude toward the drugs. They frequently don't follow the instructions for use, choosing instead to downplay their pain. As a result, many suffer needlessly. I know I observed my elderly mother behaving this way, and I became curious about other elderly people.

Researchers conducted in-depth interviews with men and women ages 67 to 92, who had severe hip or knee osteoarthritis. They asked the study participants to gather all their prescription and nonprescription medications and then discussed the doses and timing of each. The researchers posed such open-ended questions and as:

What does your osteoarthritis feel like at this time? What are you doing for your osteoarthritis? What other medications are you taking? Do you take your medication in the way your health care professionals suggested? Why or why not? Do you take your medications regularly? Why or why not?

Most participants took medications for other conditions too, but they viewed painkillers as different. They were reluctant to take pain pills and often didn't follow label directions. Although the participants generally follow the instructions on their other medications, most purposely took pain relievers less often than recommended or at lower doses.

The interviewees also followed different medication behaviors when it came to pain relievers. The elderly men and women did not place painkillers in their pill organizer along with their other medicines. One woman filled her prescription for an opioid pain reliever, and then threw away the bottle. Another recorded how many acetaminophen tablets she took each day and put lower dose acetaminophen in the bottle for the extra strength product. Some took less pain medication when it was about to run out, although they did not do this with other medication.

What reasons did people give for not wanting to take pain medications or for cutting back on dosages? Most said that they didn't like to take pills, although several of them took many pills each day, plus dietary supplements. Several feared addiction. One participant referred to a common opioid pain reliever as a hard drug and said it reminded her of drug use on the street. Others had similar concerns, noting that taking pain relievers had become a habit more than a necessity.

Yet some of the participants hold friends and family to a different standard, scolding them for not taking their pain medications as described.

Many of these older people with osteoarthritis dismissed their pain or made light of it, even though pain restricted their activities. They claimed that at their age paint was to be expected. That's how you know you're alive, one man remarked. Several others justify taking less pain medication than prescribed by claiming to have a high tolerance for pain. Or they expressed the need to fight the pain and not give into it. Many participants said they would take pain relievers only if the pain became very bad.

The researchers noted that noncompliance with pain medication may indicate a person's refusal to accept that arthritis - associated pain warrants treatment. As a result, doctors may want to omit or clarify the instruction "as needed" on pain medication.

Also, educating older people with osteoarthritis about the safety of opioid avoid pain relievers and the need to take all pain medications as directed may relieve their concerns about addiction and improve their quality of life.