Opioids Should Be Avoided For Treating Back Pain in Older Adults: Study

Amid continuing concerns about the overuse of opioid-based pain medications in recent years, which have resulted in widespread abuse and addiction, researchers warn that older patients should not be prescribed the powerful narcotics to treat back and neck pain.

In a study published last month in the medical journal Drugs & Aging, researchers from the Boston University School of Medicine and Boston Medical Center conducted a review of findings from prior studies involving spine, neck, and back pain in older adults, leading them to conclude that opioids like Vicodin and OxyContin should be avoided.

Researchers indicate elderly patients have a wide range of effective options for treating back pain, but warn opioids carry a number of serious side effects of older patients, including an overall increase in the mortality risk

The study involved a review of 138 double-blind, placebo-controlled trials focusing on efficacy of medications for spine pain, and researchers cross-searched for common drug classes and clinical trials involving patients over 65 years old.

The findings provided strong evidence that older patients can effectively treat much of their pain using non-steroidal anti-inflammatory drugs (NSAIDs), but researchers indicate adjustments for gastrointestinal and kidney risk factors should be made. Additionally, these drugs should be used on a limited basis, for two to three days at a time when pain flares, but they should not be used for weeks on end.

Acetaminophen is also an effective treatment for pain among older adults, but NSAIDs are much safer for use because of the kidney, stomach, and liver issues acetaminophen can cause.

There was mixed evidence to show gabapentin and pregabalin helped treat nerve pain, especially for things like sciatica. There was also good evidence to show serotonin–norepinephrine reuptake inhibitor (SNRI) antidepressants effectively treat neuropathic pain as well and there was evidence indicating tramadol works well for older patients.

Using medications like gabapentin can lead to other side effects which may potentially be dangerous for older patients, such as increased dizziness and balance problems, which might result in falls.

Muscle relaxers pose a risk of sedation and falls. Drugs like tizanidine and baclofen can be given to elderly patients in low doses to avoid some of these risks.

Antidepressants are effective in some patients and may be a good choice for those who are suffering from pain and depression. Other options can also include injections and corticosteroids for chronic pain. Long term pain may also require a patient to undergo physical therapy as well, to help improve and maintain mobility and function.

Researchers said there is not one single option that is well suited for every patient and choices should be tailored based on a patient’s background and medical history, as well as the specific pain they are treating.

“Whenever possible, beneficial geriatric spine pain pharmacotherapy should employ the lowest therapeutic doses with consideration of polypharmacy, potentially decreased renal and hepatic metabolism, and co-morbid medical disorders,” the researchers wrote.

The study’s authors recommended elderly patients avoid opioid painkillers whenever possible because of the risk it poses to those patients. This point is especially important considering the worsening opioid epidemic affecting the US in recent years, largely blamed on doctor prescribing habits.

Despite efforts to curb opioid use, nearly one-quarter of US adults with chronic pain received an opioid prescription in 2019 for painkillers like Norco or Vicodin. To that end, federal drug regulators are considering a mandatory education program for doctors dispensing opioids.