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Spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and kidney function, comorbid medical problems, and polypharmacy (the simultaneous use of multiple drugs to treat medical conditions).
Now a new review study has found acetaminophen is safe in older adults, but non-steroidal anti-inflammatories (ibuprofen) may be more effective for spine-related pain. Non-steroidal anti-inflammatories should be used short-term in lower dose courses with gastrointestinal precaution while corticosteroids show the least evidence for treating non-specific back pain.
Additionally, nerve pain medications (gabapentin and pregabalin) can be used in older persons, with caution to dose and kidney function. Newer antidepressants (duloxetine) more so than older ones (nortriptyline) can help with spine-related pain, with attention to possible sedation and dizziness. Some muscle relaxants (baclofen and tizanidine) can be used in older persons, again accounting for kidney and liver function. Opioids have limited use in common spine-related pain, but can be used with caution in cases that don't respond to treatment.
"Most older people experience neck or low back pain at some point, bothersome enough to see their doctor. Our findings provide a helpful medication guide for physicians to use for spine pain in an older population that can have a complex medical history," explained corresponding author Michael D. Perloff, MD, Ph.D., assistant professor of neurology at Boston University School of Medicine (BUSM) and a neurologist at Boston Medical Center.
The researchers performed a literature review to assess the evidence-basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. They then provided their recommendations based on safe and effective dosing.
Among their findings:
According to the researchers, complementary medicine, physical therapy, injections, and surgery all have a place to help older persons with spine-related pain. "Medications used at the correct dose, for the correct diagnosis, adjusting for pre-existing medical problems can result in better use of treatments for spine pain," added first author Jonathan Fu, a 2022 MD graduate from BUSM.