Controversy over treatment for elderly with chronic pain

American seniors suffering from chronic pain may be better off taking opioid painkillers such as codeine rather than over-the-counter products such as ibuprofen, according to new guidelines from the American Geriatrics Society (AGS).

The updated guidelines recommend that doctors instruct their patients to avoid NSAIDs (non-steroidal anti-inflammatory drugs) and opt instead for a low-dose opioid therapy.

Acetaminophen, including Tylenol, remains the top choice for treating chronic pain, but for those patients unable to get relief, the next step on the treatment ladder is opioids, the guidelines say, providing that patients and their caregivers are screened for previous substance abuse.

The new guidelines have sparked controversy within the medical community, not only because of the potential addictive concerns related to opioids, but also because of their side effects, which include respiratory problems, constipation, fatigue and nausea.

“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,” Dr Bruce Ferrell, chair of the AGS Panel on Pharmacological Management of Persistent Pain in Older Persons, told the Reuters news agency.

However, other medical authorities were not so quick to endorse the opiod recommendation due to reports of misuse and diversion of prescription drugs and related deaths.

“Persistent pain isn’t a ‘normal’ part of aging and should not be ignored,” said Dr Cheryl Phillips, president of the AGS.

“As seniors become susceptible to more complex health ailments, the need for a clear and precise pain management plan is key,” she said.

The new guidelines, unveiled recently at the AGS annual meeting in Chicago, are focused primarily on those ages 75 and older who experience chronic pain. This group tends to be frail and suffer with multiple chronic conditions that cause persistent pain.

The AGS panel concluded that the risks of NSAIDs for older patients, which include increased risks of gastrointestinal and cardiovascular disorders, typically outweigh the benefits.

NSAIDs have a lot of drug-disease interactions, for those with heart failure and high blood pressure, and for patients who any renal insufficiency.

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. The updated guidelines will be published in the August issue of the Journal of the American Geriatrics Society.