title: Persistent nonmalignant pain management using nonsteroidal anti-inflammatory drugs in older patients and use of inappropriate adjuvant medications.
abstract: OBJECTIVE
  Due to the high risk of life-threatening side effects, nonsteroidal anti-inflammatory drugs (NSAIDs) are not favored for treating persistent nonmalignant pain in the elderly. We report national prescription trends with determinants of NSAIDs prescription for persistent nonmalignant pain among older patients (age 65 and over) in the US outpatient setting.
  
  
  METHODS
  A cross-sectional analysis was performed using National Ambulatory Medical Care Survey data. Prescriptions for NSAIDs, opioids, and adjuvant agents were identified using five-digit National Ambulatory Medical Care Survey drug codes.
  
  
  RESULTS
  About 89% of the 206,879,848 weighted visits in the US from 2000 to 2007 recorded NSAIDs prescriptions in patients (mean age =75.4 years). Most NSAIDs users had Medicare (75%), and about 25% were prescribed with adjuvant medications considered inappropriate for their age. Compared to men, women were 1.79 times more likely to be prescribed NSAIDs.
  
  
  CONCLUSIONS
  The high percentage of NSAIDs prescription in older patients is alarming. We recommend investigating the appropriateness of the high prevalence of NSAIDs use among older patients reported in our study.
authors: Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA.
authors: Nahid
authors: N
authors: Rianon
authors: Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA.
authors: Maureen E
authors: ME
authors: Knell
authors: Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA.
authors: Walter
authors: W
authors: Agbor-Bawa
authors: Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
authors: Joan
authors: J
authors: Thelen
authors: Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA.
authors: Crystal
authors: C
authors: Burkhardt
authors: Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA.
authors: Rafia S
authors: RS
authors: Rasu
keywords: AGS guideline; NAMCS; NSAIDs; inappropriate adjuvant; pain management