Osteoarthritis in Older Adults: Nonsteroidal Anti-Inflammatory Drugs Versus Opioids

Persistent pain in older adults as a result of osteoarthritis (OA) has various treatment options, and all of them have significant risks. An oral nonsteroidal anti-inflammatory drug (NSAID) or an opioid can be considered as a treatment option when persistent pain is not controlled by nonpharmacological interventions and regularly scheduled doses of acetaminophen. However, NSAIDs are nephrotoxic and may cause upper gastrointestinal bleeding. These risks can be mitigated through the initiation of a proton-pump inhibitor and careful monitoring of renal function and serum electrolytes. A low-dose opioid taken as needed can be considered as a treatment option if the pain is not controlled by NSAIDs as long as the risks associated with central nervous system depression and dose escalation as a result of tolerance are monitored closely. The complete patient profile must be taken into consideration when determining the best option.