Chronic pain management in older adults: with coxibs under fire, what now?

Chronic non-cancer pain is notoriously undertreated, especially when the source cannot be identified by objective testing. Effective treatment often requires a combination of pharmacologic and non-pharmacologic approaches. This article describes current medication management of chronic pain, with particular attention to opioids. Acetaminophen and anti-inflammatories are first-line drugs for mild to moderate pain. For neuropathic pain, anticonvulsants are finding an increasing role, as are topical agents. Antidepressants are often advisable. Regarding opioids, the article addresses concerns about addiction potential; distinguishes between addiction and physical dependency; details the role of tolerance to different effects of opioids; and discusses their safety. With appropriate dosing, vigilant management, and careful tapering, opioids are a safe and effective choice for pain management in older adults. Appropriate follow-up guidelines are presented.