Older Adults and Chronic Pain Management: Aspirin’s Past Its Prime

For decades, aspirin was the Swiss Army knife of the medicine cabinet. Headache? Aspirin. Arthritis? Aspirin. Stubbed your toe? You guessed it—aspirin. Baby aspirin for a baby, hard stop. But when it comes to chronic pain management in older adults, this once-beloved OTC staple may be showing its age.

Chronic pain affects more than half of adults older than 65 years, often making everyday activities—from climbing stairs to opening pickle jars—far more difficult than they should be. The challenge isn’t simply treating pain. It’s doing so without creating an entirely new set of problems.

As we age, our kidneys become a little less forgiving and functional, our stomach lining becomes a little more delicate, and our medication lists tend to grow exponentially. Suddenly, every pain medication deserves a pause. Enter aspirin.

Aspirin works by irreversibly blocking cyclooxygenase (COX-1 and COX-2) enzymes, reducing the production of prostaglandins that contribute to pain and inflammation, while also permanently inhibiting platelet function for the life of the platelet (about a week), which means its ability to increase bleeding risk hangs around much longer than its pain-relieving effects. That’s where things become complicated for older adults.

Today’s geriatric pain management recommendations generally steer clinicians toward acetaminophen, along with topicals, as the initial medication for many types of mild chronic nociceptive pain, provided there are no contraindications.¹ When inflammation is the primary culprit—think osteoarthritis of the knee or hand—topical nonsteroidal anti-inflammatory drugs (NSAIDs) frequently get the win, as they provide meaningful pain relief with far less medication reaching the bloodstream than oral NSAIDs.

Meanwhile, oral NSAIDs—including aspirin—have become more of a “proceed with caution” option. If they’re utilized at all, the goal is the lowest effective dose for the shortest possible duration after carefully weighing gastrointestinal, renal, and cardiovascular risks.

One of the biggest misconceptions? Baby aspirin can be used for pain, but it is not a pain medication. Never skip the small stuff, pun intended, and always provide even the most basic health care information to patients and caregivers alike.

Many older adults continue taking an 81-mg aspirin every morning, but that’s typically for cardiovascular protection, not pain relief. These days, that use is really reserved for secondary prevention—a separate topic and guideline of its own. Even that practice has evolved. Current recommendations discourage starting low-dose aspirin for primary prevention of cardiovascular disease in most adults 60 years and older because the bleeding risk often outweighs the cardiovascular benefit.² Of course, patients with a history of heart attack, ischemic stroke, or established cardiovascular disease are a different story, where aspirin often remains an important part of therapy.^3,4

For chronic pain, however, aspirin’s risk-benefit ratio simply isn’t what it used to be. Gastrointestinal bleeding, peptic ulcers, hemorrhagic stroke, anemia, worsening kidney function, and clinically significant drug interactions all become increasingly common with advancing age—especially in patients taking anticoagulants, corticosteroids, or multiple medications. All of a sudden, this conversation starts to sound like a direct-to-consumer medication TV ad!

The good news? Chronic pain management has also evolved while maintaining reliable, relatively safe, and effective options.

Exercise, physical therapy, weight management, cognitive behavioral therapy, and other nonpharmacologic approaches continue to serve as the foundation of successful pain care.⁵ When medications are needed, the goal isn’t simply lowering a pain score—it’s improving function while minimizing harm. That means regularly reassessing whether medications are helping, causing problems, or no longer needed.

So, has aspirin completely retired from pain management? Not quite. It can still have a role for carefully selected healthy patients. But as an OTC treatment for chronic pain in older adults, aspirin has largely been replaced by safer, more targeted options. Choose wisely, my friends!

REFERENCES

1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372

2. Davidson KW, Barry MJ, Mangione CM, et al; US Preventive Services Task Force. Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA. 2022;327(16):1577-1584. doi:10.1001/jama.2022.4983

3. Luepker RV, Van’t Hof JR, Eder M, Finnegan JR, Oldenburg N, Duval S. Aspirin use for primary prevention in older adults. J Am Geriatr Soc. 2023;71(12):3927-3929. doi:10.1111/jgs.18543

4. Berger JS. Aspirin for primary prevention—time to rethink our approach. JAMA Netw Open. 2022;5(4):e2210144. doi:10.1001/jamanetworkopen.2022.10144

5. National Institute for Health and Care Excellence. Chronic Pain (Primary and Secondary) in Over 16s: Assessment of All Chronic Pain and Management of Chronic Primary Pain. NICE Guideline No. 193. National Institute for Health and Care Excellence (NICE); 2021. Accessed July 7, 2026. https://www.ncbi.nlm.nih.gov/books/NBK569960/