Updated Guidelines for Treatment of Older Adults’ Pain

An expert panel of the American Geriatrics Society warned that non-steroidal anti- inflammatory drugs (NSAIDs) or high-dose aspirin should not be used long-term for adults 75 or older with chronic pain. The panel stated that people who cannot get relief with alternatives like acetaminophen might be better of taking opiates. The guideline recommends that acetaminophen be considered as initial and ongoing pharmacotherapy of patients with mild to moderate musculoskeletal pain, but — in a significant departure from the 2002 guideline — recommends that nonselective NSAIDs and COX-2 selective inhibitors be considered rarely, with caution, in highly selected individuals. The new guideline recommends that all patients with moderate to severe pain, pain-related functional impairment or diminished quality of life due to pain be considered for opioid therapy. The new guideline also provides new references and discussions regarding use and limitations of newer adjuvant, topical, and other drugs for recalcitrant pain problems.