It may be better for elderly people with chronic pain to take opioid painkillers such as codeine rather than familiar over-the-counter products such as ibuprofen, according to guidelines from the American Geriatrics Society (AGS).

The new recommendations advise doctors to have their patients avoid NSAIDs (non-steroidal anti-inflammatory drugs) and COX-2 inhibitors and consider the use of 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,” Dr. Bruce Ferrell noted in a telephone interview with Reuters Health.

In a prepared statement, Dr. Cheryl Phillips, president of the AGS, said: “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.”

The updated guidelines, which were presented this week at the AGS’s annual meeting in Chicago, focus primarily on people with chronic pain who are 75 years of age or older. This group tends to be frail and have multiple chronic illnesses that cause persistent pain, explained Ferrell, chair of the AGS Panel on Pharmacological Management of Persistent Pain in Older Persons.

The panel concluded that the risks of NSAIDs for older patients, which include increased risks of cardiovascular and gastrointestinal disorders, usually outweigh the benefits, and the revised guidelines reflect this, he added.

In addition, “NSAIDs have a lot of drug-disease interactions,” Dr. Ferrell noted. For example, with high blood pressure and heart failure “and for patients who have a little bit of renal insufficiency, NSAIDs are a little bit dangerous in these groups.”

The panel recommends that NSAIDs and COX-2 inhibitors be considered only rarely, and with extreme caution, for selected individuals. Instead, all patients with moderate to severe pain or diminished quality of life due to pain should be considered for opioid therapy, which may be safer in the long term.

“Although we are saying that opioids are a reasonable choice for a lot of patients,” Ferrell pointed out that “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.”

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

By Megan Rauscher
NEW YORK (Reuters Health)