Skip to main content

All Access Subscription

Get unlimited access to our full publication and article library.

Get Access Now

Interested in Group Sales? Learn more

New guidelines for persistent pain in elderly

The American Geriatrics Society has updated its "Pharmacological Management of Persistent Pain in Older Persons" guideline first published 11 years ago and last updated in 2002. The most dramatic change in the guideline is the new recommendation that NSAIDs (both nonselective NSAIDs and COX-2 inhibitors) should be considered only with "extreme caution" in older adults in whom other safer therapies have failed. Absolute contraindications for NSAIDs include chronic kidney disease and heart failure, and relative contraindications include hypertension, H. pylori infection, history of peptic ulcer disease, and concomitant use of corticosteroids or SSRIs. If a nonselective NSAID must be used in older persons or if a COX-2 inhibitor is given with aspirin, a proton pump inhibitor or misoprostol should also be used for gastrointestinal protection. The guideline further recommends that all patients on a nonselective NSAIDs or COX-2 inhibitor should be routinely assessed for gastrointestinal and renal toxicity, hypertension, heart failure, and other side effects. Acetaminophen should be considered as "initial and ongoing pharmacotherapy in the treatment of persistent pain," particularly for musculoskeletal pain. Opioids may be considered in all patients with moderate-to-severe pain or diminished quality of life due to pain. Patients with fibromyalgia or neuropathic pain are candidates for adjuvant analgesics. The full guideline is available at www.americangeriatrics.org.