title: Persistent pain in the older adult: what should we do now in light of the 2009 American geriatrics society clinical practice guideline?
abstract: The recent publication of revised guidelines for the management of persistent pain in the older adult (American Geriatric Society, 2009) has posed a dilemma for clinicians. In essence, these revised guidelines now downplay the use of nonsteroidal anti-inflammatory drugs (NSAIDs) relative to prior year's recommendations. The strong recommendation for caution when employing NSAIDs is because of the numerous, well-documented, potential adverse effects including renal failure, stroke, hypertension, heart failure exacerbations, and gastrointestinal complications. Nevertheless, physicians still have a substantial arsenal for combating chronic pain due to such conditions as degenerative arthritis and back problems. Options for intervention include physical therapy, topical nonsteroidals, capsaicin, topical lidocaine, intra-articular therapies, and judicious use of narcotics. In the future, cyclooxygenase-inhibiting nitric oxide-donating drugs may represent a technical improvement in the toxicity profile of traditional NSAIDs.
authors.affiliation: Division of Rheumatology, The George Washington University, Washington, DC 20037, USA. jkatz@mfa.gwu.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Katz
authors.forename: Tina
authors.initials: T
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D019317:Evidence-Based Medicine; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006299:Health Services for the Aged / Q000458:organization & administration*; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D009141:Musculoskeletal System / Q000187:drug effects; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency / Q000139:chemically induced; D012955:Societies, Medical; D020521:Stroke / Q000139:chemically induced; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal