Non-Opioid Medications for Senior Chronic Pain: Gabapentin, Duloxetine, Lidocaine, Topical NSAIDs

Opioids carry real risks in older adults: falls, confusion, constipation, and the chance of long-term dependence. The 2019 American Geriatrics Society Beers Criteria flags chronic opioid use in adults over 65 as something to avoid when other options will work. Four non-opioid prescription paths cover most chronic pain in seniors: gabapentin and pregabalin for nerve pain, duloxetine for both pain and depression, lidocaine patches for one specific painful area, and topical NSAIDs (diclofenac gel) for knee and hand arthritis. Each has a different role, a different cost, and a different safety profile.

Gabapentin (brand name Neurontin) treats nerve pain such as burning feet from diabetic neuropathy, post-shingles pain (postherpetic neuralgia), and some kinds of sciatica. Doses for adults over 65 start very low (100 milligrams at bedtime) and increase slowly over weeks. The most common side effect is daytime drowsiness, which raises fall risk. Medicare Part D covers generic gabapentin for under $10 a month at most pharmacies. Pregabalin (Lyrica) works the same way but is more expensive and often costs $100 or more per month even on Medicare.

Duloxetine (Cymbalta) is the most versatile drug on the list because it treats nerve pain, low-back pain, fibromyalgia pain, and depression all from one daily capsule. Starting dose for seniors is 30 milligrams in the morning, increased to 60 milligrams after a week if tolerated. Side effects include nausea (lasts about a week), dry mouth, and constipation. Generic duloxetine costs $5 to $15 a month under Part D. Duloxetine is particularly helpful when chronic pain and low mood feed each other.

Lidocaine 5 percent patches (Lidoderm) numb a small area of skin for up to 12 hours. They are a good choice for shingles pain after the rash heals, for a single painful knee, or for chronic low back pain in one spot. Up to three patches can be worn at once. They do not cause drowsiness or fall risk because almost none of the lidocaine reaches the bloodstream. Cost on Medicare Part D varies widely — generic lidocaine 5 percent patches run $50 to $150 for a 30-day supply. A lower-strength over-the-counter version (4 percent) is sold at pharmacies for less and works for milder pain.

Topical NSAID diclofenac sodium 1 percent gel (Voltaren Gel) became available without a prescription in 2020 and is now sold at every U.S. pharmacy. The 2019 Geriatrics Society guideline endorses it as the preferred first-line treatment for knee and hand arthritis pain in adults over 65 because the gel form delivers anti-inflammatory medicine to the joint without the kidney and stomach risks of oral ibuprofen or naproxen. Cost runs $15 to $25 for a 100-gram tube, which lasts most users about a month.

This is not medical advice. Each drug has interactions with common heart, blood pressure, and diabetes medications. Always review the full list with your doctor or pharmacist before starting. The pain log from the previous guide will help your prescriber pick the right one.

(Sources: American Geriatrics Society 2019 Pharmacological Management of Persistent Pain in Older Persons; 2019 AGS Beers Criteria; Medicare.gov Part D plan finder; FDA Voltaren Arthritis Pain OTC approval announcement, accessed May 2026)