Management of pain in patients with multiple health problems: a guide for the practicing physician

Chronic pain is a universal problem that is especially prevalent in the elderly population. Current drug therapy for pain management is limited to acetaminophen, centrally acting analgesics (opioids), and nonsteroidal anti-inflammatory drugs (NSAIDs). Although NSAIDs are the most commonly used drugs for the treatment of chronic pain, their use is associated with a high degree of gastrointestinal (GI) and renal morbidity. Furthermore, practicing physicians are faced with the dual challenge of controlling chronic pain, as well as controlling the side effects of pain medication, in patients with multiple health problems. Polypharmacy and the use of over-the-counter (OTC) medications are important considerations in this cohort of patients. A comprehensive pharmacologic treatment strategy includes NSAIDs and, when NSAIDs are deemed inappropriate, other suitable pain medications.