"Because the most com strategy for management of persistent pain among older persons is the use of pharmacologic agents, and because this is also the area of greatest risk, we chose to focus on pharmacotherapy in this update," Dr. Edlin Ferrell, guidelines panel chair, said in an AGS news release. But this is a risky strategy in older patients, because the cardiovascular, gastrointestinal and other risks posed by the drugs often outweigh the benefits, the They said NSAIDs and cox-2 inhibitors should be used rarely, and with extreme caution, in highly selected patients. "Since the two previous AGS publications, new drugs have been introduced and management strategies have been more fully evaluated,. All older patients with moderate to severe pain or diminished quality of life due to pain should be considered for opioid therapy, which may be safer for many patients than long-term use of NSAIDs, according to the updated guidelines.

The original guidelines recommended the use of over-the-counter or prescription NSAIDs and cox-2 inhibitors such as aspirin or ibuprofen before seniors were prescribed an opioid drug to treat persistent pain.