Opioids For Elderly With Chronic Pain
Posted on: Thursday, 7 May 2009, 07:50 CDT
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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Source: redOrbit Staff & Wire Reports
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User Comments (1)
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Posted by Mark Montgomery on 05/07/2009, 10:03 For chronic pain the elderly are better off smoking marijuana, not only because of the pain relieving properties of the pot but also because they can grow their own pain killers and pay zero to the local pharmacy. Pot should be legal. Mexico just legalized possession of small amounts of all drugs. Portugal decriminalized all drugs in 2001 and their experience has been positive. Now if you are caught with a 10 day supply of your drug or less you face an administrative court, not a criminal court, but in practice they are just not arresting people. A group of 10,000 very serious policemen, prosecutors, attorneys and citizens have formed a group to legalize ALL drugs, Law Enforcement Against Prohibition (http://leap.cc ) They see what happened when we legalized alcohol in 1932 as a good example of how drug legalization would work. This foolish war on drugs has lasted 37 years and cost us over a TRILLION dollars and we are not an inch closer to stopping drugs. How many millions of Americans are we going to lock up in prison for decades? Mark Montgomery boboberg@nyc.rr.com |
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