New Pain Guideline for Older Patients

Abstract

PHYSICIANS TREATING PATIENTS aged 75 years or older for chronic pain should avoid using nonsteroidal anti-inflammatory drugs (NSAIDs), according to an updated guideline issued by the American Geriatrics Society (AGS) in May. NSAIDsshouldbe“consideredrarely, and with extreme caution, in highly selected individuals,” the new guideline states, contradicting the AGS’s 2002 guideline.Thenewrecommendationreflects evidence about serious cardiovascular and gastrointestinal tract risks associated with this class of drugs that has emerged since 2002, said Bruce Ferrell, MD, chair of the panel that created new guideline and professor of medicine and geriatrics at the University of California, LosAngeles.Thesedrugsalsomaycomplicate the treatment of common conditions in this population, such as hypertension and congestive heart failure. Acetaminophen remains the initial therapy of choice, though the guideline cautions against using it in patients with liver conditions. But it encourages physicians to consider opioids for elderly patients with persistent pain. Persistent pain is a common and often undertreated problem in older adults, according to the AGS. Such pain is particularly common among those with degenerative spine conditions, arthritis, nightly leg pain, or those with cancer. But selecting an appropriate analgesic for older patients who may have multiple conditions and who may take several medications requires careful thought. Ferrell notes that nondrug therapies also may be appropriate and have been addressed in previous versions of the guideline. Despiteanimprovedunderstandingof the risks that NSAIDs pose to older patients, including that of gastrointestinal bleeding, these drugs have remained a