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Pharmacological Management of Persistent Pain in Older Persons: Focus on Opioids and Nonopioids

https://doi.org/10.1016/j.jpain.2010.11.006Get rights and content
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Abstract

Managing persistent pain is challenging, particularly in older adults who often have comorbidities and physiological changes that affect dosing and adverse effect profiles. The latest guideline issued by the American Geriatrics Society in 2009 is an important clinical resource on prescribing analgesics for older adults. This guideline helps form an evidence-based approach to treating persistent pain, along with other current endorsements, such as the relevant disease-specific recommendations by the American College of Rheumatology, the European League Against Rheumatism, and Osteoarthritis Research Society International, as well as opioid-specific guidelines issued by the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards of the United States, and the American Society of Interventional Pain Physicians. Safety is of utmost concern, especially for older adults; these guidelines include key approaches for safe opioid prescribing. Combining analgesics that have multiple mechanisms of action with nonpharmaceutical approaches can be beneficial in providing pain relief. Nontraditional analgesics are also considered on a case-by-case basis, and a few of these options are weakly recommended. Therapies should be initiated at the lowest possible dose and slowly titrated to effect, while tailoring them to the therapeutic and side-effect responses of the individual.

Perspective

For treating persistent pain in older adults, acetaminophen and opioids are important therapies in the analgesic armamentarium. In contrast, oral nonselective and selective NSAIDs should rarely be used. All patients with neuropathic pain are candidates for treatment with adjuvant analgesics; those with localized neuropathic pain can benefit from topical lidocaine.

Key words

Guidelines
persistent pain
recommendations
treatment
analgesics

Cited by (0)

Grants/research support from Merck and HCR-Manor Care; Consulting fees from CDC, American College of Rheumatology, Novartis, Endo Pharmaceuticals Inc., American Geriatrics Society, Merck, HCR-Manor Care, Genentech, Amgen, Purdue, and Pfizer; Speaker's bureau from Novartis, Genentech, Purdue, Amgen, Endo Pharmaceuticals Inc., Merck, MER, American Geriatrics Society; Ownership interest/shareholder: Smart E-Records, Allscripts; Royalty/patent holder: Humana Press (Springer); Royalties: DiaMedica Publishing; Royalty contract: Smart E-Records.

An educational grant was provided by Endo Pharmaceuticals Inc. for the symposium on which this paper was based and for subsequent manuscript development.

Publication of this article was supported by Endo Pharmaceuticals Inc.