New Guidelines Recommend Opioids for Seniors' Pain

THURSDAY May 7, 2009 -- The use of non-steroidal anti-inflammatory drugs (NSAIDs) or cox-2 inhibitors to treat persistent pain in seniors should be drastically reduced, according to new pain management guidelines released this week by the American Geriatrics Society (AGS).

The original guidelines recommended the use of over-the-counter or prescription NSAIDs and cox-2 inhibitors such as aspirin or ibuprofen before seniors were prescribed an opioid drug to treat persistent pain.

But this is a risky strategy in older patients, because the cardiovascular, gastrointestinal and other risks posed by the drugs often outweigh the benefits, the authors of the new guidelines said. They said NSAIDs and cox-2 inhibitors should be used rarely, and with extreme caution, in highly selected patients.

All older patients with moderate to 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, according to the updated guidelines.

"Because the most common strategy for management of persistent pain among older persons is the use of pharmacologic agents, and because this is also the area of greatest risk, we chose to focus on pharmacotherapy in this update," Dr. Bruce Ferrell, guidelines panel chair, said in an AGS news release.

"Since the two previous AGS publications, new drugs have been introduced and management strategies have been more fully evaluated, so we felt it was important to focus on pharmacotherapy in this update," Ferrell explained.

The new guidelines will appear in the August issue of the Journal of the American Geriatrics Society.

Persistent pain is common among older people. If ongoing pain is ignored or incorrectly treated, patients can suffer problems such as falls, sleep disruptions, depression and anxiety, according to background information in the release.

"Persistent pain isn't a 'normal' part of aging and should not be ignored. As seniors become susceptible to more complex health ailments, the need for a clear and precise pain management plan is key," Dr. Cheryl Phillips, AGS president, said in the news release.

More information

The National Pain Foundation has more about seniors and pain.

Posted: May 2009


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