Opioids For Elderly With Chronic Pain
New guidelines from the American Geriatrics Society (AGS) say elderly people with chronic pain may be better off taking opioid painkillers such as codeine rather than over-the-counter products such as ibuprofen.
The updated guidelines, which were presented this week at the AGS’s annual meeting in Chicago, advise doctors to have their patients avoid NSAIDs and COX-2 inhibitors, and opt for low-dose opioid therapy instead.
"For a lot of elderly patients with multiple medical problems and who are at high risk for complications from NSAIDs, they may be better off in the long run taking low-dose opioids," said Dr. Bruce Ferrell, chair of the AGS Panel on Pharmacological Management of Persistent Pain in Older Persons, during a telephone interview with Reuters.
"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,” said Dr. Cheryl Phillips, president of the AGS, in a prepared statement.
The new guidelines are focused primarily on those 75 years of age and older with chronic pain, a group that tends to be frail and suffer with multiple chronic conditions that cause persistent pain, said Ferrell.
The panel concluded that the risks of NSAIDs (non-steroidal anti-inflammatory drugs) for older patients, which include increased risks of gastrointestinal and cardiovascular disorders, typically outweigh the benefits, something reflected in the new guidelines, he said.
Furthermore, "NSAIDs have a lot of drug-disease interactions,” for those with heart failure and high blood pressure, he said.
"And for patients who have a little bit of renal insufficiency, NSAIDs are a little bit dangerous in these groups."
The panel recommended that COX-2 inhibitors and NSAIDs be considered only rarely and with extreme caution for selected individuals.
Rather, all patients with moderate to severe pain or lower quality of life due to pain should be considered for opioid therapy, which may be a safer treatment over the long term.
"Although we are saying that opioids are a reasonable choice for a lot of patients”¦.a lot of physicians are frightened sometimes to start down that road of giving opioids for chronic pain, especially non-cancer-related pain, so in some circles it is controversial,” Ferrell said.
The updated guidelines will be published in the August issue of the Journal of the American Geriatrics Society.
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