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    Thursday, June 4, 2009

    Experts Warn Against Long-Term Use Of Common Pain Pills

    Experts Warn Against Long-Term Use Of Common Pain Pills—Especially In Seniors

    Aspirin and ibuprofen are staples in just about every medicine chest and first aid kit. They’re sold over the counter, and they’re not expensive.
    Most people don’t think twice about taking them.But NSAIDS are dangerous especially in seniors.

    BRAND NAMES of just a few NSAIDS— Cataflam®; Flector®; Solaraze®; Voltaren — Aleve® [OTC]; Anaprox®; Anaprox® DS; EC-Naprosyn®; Mediproxen [OTC]; Midol® Extended Relief; Naprelan®; Pamprin® Maximum Strength All Day Relief [OTC] — Apo-Keto-E®; Apo-Keto®; Novo-Keto; Novo-Keto-EC; Nu-Ketoprofen; Nu-Ketoprofen-E; Oruvail®; Rhodis SR™ ; Rhodis-EC™ ; Rhodis™ Flexin® ; Indocin®;

    Seniors especially those over age 75 should be very careful about taking NSAIDS on a long term basis. An expert panel of American Geriatrics Society pretty much bumped all non-steroidal anti-inflammatory drugs, or NSAIDs, off the list of medicines recommended for adults ages 75 and older with chronic, persistent pain and on a long term basis. Long-term use of drugs like ibuprofen, naproxen and high-dose aspirin is so dangerous, the panelists said, that elderly people who can’t get relief from alternatives like acetaminophen [Tylenol] may be better off skipping to stronger pain medications like opiates.

    All this despite the fact that NSAIDs are known to be effective for chronic pain conditions that often plague older adults — and despite the fact that opiates can be addictive.
    There really continues to be a significant amount of unrecognized and untreated pain in older people, and it’s a huge problem. Chronic pain is rampant among the elderly, affecting an estimated 25 to 50 percent of elderly people living in the community and up to 85 percent of nursing home residents. Often caused by degenerative spine conditions, arthritis and cancer or cancer treatment, chronic pain takes a powerful toll on quality of life. Untreated, chronic pain can disrupt sleep and affect mood, restrict mobility and lead to depression, anxiety and isolation, experts say. It can also contribute to falls, which lead to further complications and often death.

    “We’ve come out a little strong at this point in time about the risks of NSAIDs in older people,” said the chair of the panel that made the recommendations and a professor of geriatrics at the University of California, Los Angeles. “We hate to throw the baby out with the bathwater — they do work.But it looks like patients would be safer on opioids than on high doses of NSAIDs for long periods of time,” he said, adding “that for most elderly, the risk of addiction appears to be low.”

    The risks from chronic use of NSAIDs are myriad. They can cause life-threatening ulcers and gastrointestinal bleeding, a side effect that occurs more frequently and with greater severity as people age. Some NSAIDs may increase the risk for heart attacks or strokes, and they don’t interact well with drugs used to treat heart failure. NSAIDS can make high blood pressure worse, even uncontrollable, and impair kidney function. And the list of potentially hazardous interactions with other drugs is a long one, experts say. Younger people can use this class of medicine with limited risks. In older persons, it’s a different story. Physical changes make them more sensitive.

    These are just a few of the adverse effects listed in Boxed warnings for all ages:
    Anaphylactoid reactions; Bleeding/hemostasis: Platelet adhesion and aggregation may be decreased; may prolong bleeding time; patients with coagulation disorders or who are receiving anticoagulants should be monitored closely. Anemia may occur; patients on long-term NSAID therapy should be monitored for anemia. Cardiovascular events: [U.S. Boxed Warning]: NSAIDs are associated with an increased risk of adverse cardiovascular thrombotic events, including MI, stroke, and new onset or worsening of pre-existing hypertension. Concurrent administration of ibuprofen, and potentially other nonselective NSAIDs, may interfere with aspirin's cardioprotective effect.

    Gastrointestinal events: [U.S. Boxed Warning]: NSAIDs may increase risk of gastrointestinal irritation, inflammation, ulceration, bleeding, and perforation. These events may occur at any time during therapy and without warning. Skin reactions: NSAIDs may cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN); discontinue use at first sign of skin rash or hypersensitivity. Visual disturbances: Prolonged use may cause corneal deposits and retinal disturbances; discontinue if visual changes are observed. Elderly: The elderly are at increased risk for adverse effects (especially peptic ulceration, CNS effects, renal toxicity) from NSAIDs even at low doses.

    The geriatrics society’s new guidelines say NSAIDs should be considered “rarely” in the population of frail elderly people, and used “with extreme caution” and then only in “highly selected individuals.” For those patients with moderate to severe pain that diminishes the quality of life, opiates may be considered, the guidelines suggest, after both the patient and caregiver are screened for prior substance abuse.

    In Summary the Geriatrics Society Changes Its Pain Management Guidelines. In its first revision since 2002, the society makes several recommendations, among them- Older patients with moderate-to-severe pain are candidates for opioid therapy and should only "rarely" receive nonselective NSAIDs and COX-2 selective inhibitors.

    • Acetaminophen should be the "initial and ongoing" drug treatment for persistent — "particularly musculoskeletal" — pain.
    • Nonselective NSAIDs and COX-2 selective inhibitors may be considered "with extreme caution" for patients in whom "other (safer) therapies have failed."
    • Patients with fibromyalgia or neuropathic pain are candidates for adjuvant analgesics.
    • Breakthrough pain should be treated with short-acting, immediate-release opioids.

    Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site,

    Please remember, as with all our articles we provide information, not medical advice.

    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

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