Caring Currents

Which Painkillers Are Safe for Seniors?

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Ibuprofen and other painkillers known as NSAIDs should only be used by older adults with "extreme caution," the American Geriatric Society (AGS) announced this week. The warning was part of new guidelines issued in May but published this month in the Journal of the American Geriatrics Society.

Revising chronic pain recommendations for the first time in seven years, the AGS warned that NSAIDs and another class of painkillers, COX-2 selective inhibitors, shouldn't be used by seniors except under rare circumstances. In addition to Motrin and generic ibuprofen, drugs to watch out for include newer over-the-counter painkillers such as naproxen (Aleve), and stronger prescription-strength drugs, such as celecoxib (Celebrex) and indomethacin (Indocin).

Health risks for seniors using NSAIDs include:
"1. Increased cardiovascular risk.
"2. Decreased kidney function as a result of less blood flow to the kidneys. This, in turn, can affect the way the body processes other medicines and can increase blood pressure.
"3. Irritation of the lining of the stomach and bowels, which can cause internal bleeding.

Every year literally tens of thousands of people, mostly elderly, are hospitalized because of NSAIDs.

The new guidelines, developed by the AGS Panel on the Pharmacological Management of Persistent Pain in Older Persons, aim to significantly change the way doctors manage pain in older adults.

While acetaminophen (Tylenol) is still the "first-line" painkiller recommended for seniors, the next step -- when acetaminophen doesn't work -- has changed. (And because of liver toxity issues, acetaminophen is not the best choice for heavy drinkers. Instead of trying NSAIDs or COX-2 inhibitors, doctors should go directly to prescribing opioid pain relievers, the panel said. Of course, opioids raise the issues of dependence and addiction, but even so, the risks are less than those from taking NSAIDs and COX-2 inhibitors, experts say.

It's clear that pain management for older adults has become a very complicated subject, and one worth discussing in-depth with your doctor. One question to ask if you prefer ibuprofen for pain: whether a blood test for kidney function could determine if an NSAID would be safe. And there's more you need to know about nighttime pain relievers and other products.

It's likely these new guidelines are going to open the door to a lot of discussion about how to help seniors cope with chronic pain. Let's hope raising these questions results in some new solutions.