PA Medical News about Persistent Pain; Older Persons; Pharmacological Management

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The Pharmacological Management of Persistent Pain in Older Persons
The American Geriatrics Society Practice Guidelines, 05/13/09

A major change stemming from the new guidelines is the near elimination of utilizing non-steroidal anti-inflammatory drugs (NSAIDs). Original guidelines recommended seniors use over-the-counter or prescription NSAIDs or COX-2 inhibitors such as aspirin or ibuprofen before being prescribed an opioid drug. The updated guidelines point to newer information suggesting that this is a risky strategy in older persons. The Panel states that the risks of NSAIDs in older patients - which include increased cardiovascular risk and gastrointestinal toxicity - usually outweigh the benefits and as a result, has revised the guidelines to reflect the findings. Based on newer clinical trials as well as clinical observation, the panel recommends that NSAIDs and COX-2s be considered rarely, and with extreme caution, in highly selected individuals. The guidelines recommend that all patients with moderate-severe pain or diminished quality of life due to pain should be considered for opioid therapy, which may be safer for many patients than long term use of NSAIDs. The guidelines also provide some discussions and recommendations about the use of adjuvant and other drugs for older persons with recalcitrant pain problems.