Most people don’t think about the consequences of taking too much ibuprofen or aspirin over time. But experts say that people over 75 should think twice before using NSAIDs (non-steroidal anti-inflammatory drugs) to treat their pain, especially if the pain and pill-taking are chronic. In late April, a panel of the American Geriatrics Society removed almost all NSAIDs from the list of recommended medications for adults age 75 and older with chronic pain.
Long-term use of drugs like ibuprofen, naporoxen, and high-dose aspirin is so dangerous for elderly people, the panel said, that those with moderate to severe pain who can’t get relief from alternatives like acetaminophen (the main ingredient in Tylenol®) may be better off being prescribed opioids like codeine or morphine, as long as the patient and caregiver are screened for prior substance abuse.
Dr. Bruce Ferrell, chair of the panel, explained, “We’ve come out a little strong at this point in time about the risk of NSAIDs in older people…We hate to throw the baby out with the bathwater-they do work for some people-but it is a fairly high risk when these drugs are given in moderate to high doses, especially if given over time.”
Chronic used of NSAIDs can cause potentially fatal ulcers and gastrointestinal bleeding, the latter of which occurs more frequently with age. They don’t interact well with drugs used to treat heart failure, they can make high blood pressure worse, and they can impair kidney function. Some NSAIDs may increase the risk of heart attacks or strokes, and there is a long list of potentially dangerous interactions with other drugs. The panel recommended that NSAIDs be considered “rarely” for elderly people, and used “with extreme caution” in “highly selected individuals.”
If a patient is prescribed an opioid for chronic pain, no matter his or her age, it needs to be done very carefully. Dr. Roger Chou, a pain expert who was not involved in the panel, told the New York Times that decisions about opioid therapy must be made on a case-by-case basis. “Opioids are, everyone agrees, probably the strongest pain medication you can have,” he said. “The down side is the potential for abuse, and we’re seeing huge increases nationwide of reports about the misuse and diversion of prescription drugs and related deaths…The concerns about opioids are very real.”
Chronic pain is extremely prevalent among elderly people, affecting an estimated 25 to 50 percent of elderly people in communities and up to 85 percent of those in nursing homes. If untreated, chronic pain can disrupt sleep, restrict mobility, and lead to depression, isolation, and anxiety. Non-drug treatments like physical therapy and cognitive behavioral therapy are often helpful in alleviating the pain.
Dr. Keela Herr, a professor at the University of Iowa College of Nursing in Iowa City who researches pain management in the elderly and was involved in the panel, said that although pain cannot always be entirely eliminated, “You can get to the point where it’s in the mild category-where it’s annoying but not such an impairment that you can’t function and interact and do the things that are important.”
Source: The New York Times, Roni Caryn Rabin, Experts Warn Against Long-Term Use of Common Pain Pills, May 6, 2009