New Pain Medication Guideline for Elderly Patients

The American Geriatrics Society has issued an updated guideline for treating chronic pain patients aged 75 and older.  According to the new guideline, NSAIDs (non-steroidal anti-inflammatories) should be “considered rarely, and with extreme caution, in highly selected individuals.” 

This contradicts the AGS's previous 2002 guideline, but reflects more recent evidence of serious cardiovascular and gastrointestinal tract risks associated with the use of NSAIDs.  These drugs can also complicate other conditions, such as hypertension and congestive heart failure, which are common in the elderly population. 

Instead of NSAIDs, the new guideline encourages physicians to consider opioids for older patients with chronic pain.  Although many doctors have shied away from prescribing opioids, the AGS feels that in many cases, NSAIDs are more risky than opioids for this population.  Of course, ultimately each patient's case has to be evaluated separately, weighing the risks and benefits for each class of medication, to determine what treatment is most appropriate.

I find it interesting that opioids are being recommended for older chronic pain patients at the same time that the FDA is considering new regulations that would make opioids more difficult to obtain.  Elderly patients often have a difficult enough time getting to doctor appointments and picking up their medications as it is.  Adding more hoops they'll have to jump through just seems cruel.  I hope the FDA will take that into consideration.

You can read the full AGS Guideline here:  Pharmacological Management of Persistent Pain in Older Persons

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Source:
Kuehn, Bridget M. (2009).New Pain Guideline for Older Patients. The Journal of the American Medical Association, 302(1), 19.