American Geriatrics Society Pharmacologic Guidelines for Managing Older Patients with Chronic Pain

Christine Miaskowski, PhD, RN, FAAN

Professor and Associate Dean for Academic Affairs
Department of Physiological Nursing
University of California, San Francisco
San Francisco, California

The American Geriatric Society recently updated guidelines for the pharmacologic management of pain in seniors. Persistent pain is often complex and multifactorial in older patients, who often underreport pain. Multiple comorbidities can complicate pain assessment and treatment. Older persons are also more likely to experience medication-related side effects and complications related to diagnostic and invasive procedures. The expert committee noted several pharmacologic considerations that become increasingly relevant with aging, including slowing of gastrointestinal transit time, the potential for decreases in glomerular filtration rates, and increased fat-to-lean body weight ratios that may increase the distribution volume of fat-soluble drugs. Treatment recommendations emphasize acetaminophen as first-line medication for pain, the risks of nonsteroidal anti-inflammatory drugs, and appropriate use of opioid-based regimens in this special patient population.

References

American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc. 2009 Jul 1. [Epub ahead of print]

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