Pain Drugs and LBD

Most LBD caregivers know to be very careful with anticholinergics...those drugs like antipsychotics, tranquilizers and even over the counter (OTC) cold and allergy medications. But what about pain relievers? Some like opiates do have a small amount of anticholinergic action. Does this make them safe in small doses? Others, like ibuprophen (Advil) are milder and have little or no anticholinergic action. How safe are they?

First, we have to look at the body you are putting the drugs into.

• Drug sensitivity is a serious and common LBD symptom. A PwLBD has a better than fifty percent chance of being sensitive to most antipsychotics, anti-anxiety drugs, sleep aids, cold and allergy drugs and a multitude of others. Go to the LBD Resources page on LBDtools.com and scroll down to "Helpful Documents" to find several lists of these drugs.

• Most Pw LBD are elderly. Age causes one's ANS to become less effective, making us less tolerant of drugs. The research is becoming very clear that anyone 65 or older should be very careful about using any drug that contains anticholinergics or sedatives.

• Most elderly people also have other health issues that have to be taken into consideration when choosing a pain drug. For example, if a person is already on blood thinners, they should not take a pain drug with blood thinning properties.

Given these three concerns, pain drugs that might be safe for others may not be safe for your loved one. Even drugs that might be safe for others with LBD, might not be safe for your loved one if he/she has other issues. However,you might be able to try them out and see how they work, using the following guidelines.

Know how your loved one's other conditions will limit your choices of pain drugs. For instance, he is has heart problems, those nice, mild OTC drugs like Advil may not be advised. If you are uncertain, ask the pharmacist.

Choose a mild drug. Milder acting drugs are generally safer than a drug that starts out strong. Even then, it will likely take less than a normal dose to do the job.

Choose a short-acting drug.  Better to take several pills a day than to take a drug that stays in the system a long time.

Avoid drugs that sedate.  Sedation causes an already compromised autonomic nervous system to become even more sluggish. Constipation and extreme drowsiness (or sleeping for many hours) are common symptoms.

Start low and increase the dosage very slowly until you get the result you want. If an adverse reaction appears, stop the drug immediately. Also be aware that as LBD progresses, your loved one's response to the drug can change and he may eventually need an even smaller dose or not be able to tolerate the drug any more at all.

Plan to use the drug for only a short time, just to alleviate the worst of the pain. As a general rule, pain drugs should be used for the shortest possible time. The longer a drug is used, the more likely complications will be. Addiction, for example. With an elderly loved one you might not think addiction would be a concern. "What does it matter, as long as it helps the pain," you might say. But with addiction, comes the need for an ever increasing dose to do the job, which your loved one may not be able to tolerate. Most OTC drugs are not addictive. However, long use may cause other problems, even for a younger, healthier person. For the PwLBD, these problems will likely start earlier rather than later.

Follow or pair with a non-drug alternative: One alternative to drugs is the use of essential oils. These can be used with pain in capsule form, as massage agents or in aromatherapy. These oils were used for ages before modern medicines were available. Find a person who is well versed in their use to guide you in your choices.

You can explore other methods to reduce pain such as acupuncture or acupressure, massage, music, or a multitude of stress management tools. What works best will vary depending on the source of the pain and the individual.Our latest book, Managing Cognitive Issues in Parkinson’s & Lewy BodyDementia, includes a lot of information about alternative choices.

For general information about Lewy body dementia and its care, read:
A Caregivers’ Guide to Lewy Body Dementia


Helen and James Whitworth are not doctors. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a physician's advice.