Review of Pain Relief Medications for Back and Neck Pain in Older Adults Interview with:

Michael Perloff, MD PhD Director, Neurology Pain Medicine, Boston Medical Center Assistant Professor, Boston University Medical School
Dr. Perloff

Michael Perloff, MD PhD
Director, Neurology Pain Medicine, Boston Medical Center
Assistant Professor, Boston University Medical School  What is the background for this study? 

Response: Spine-related pain (low back pain/neck pain) is very common in older adults. Physicians can be reluctant to use pain medications older patients due to reduced liver and kidney function, comorbid medical problems and background polypharmacy. We performed an extensive review of the medical literature with a focus on double-blind, placebo controlled, clinical trials.  What are the main findings?

Response:  Acetaminophen is safe in older adults, but higher dose (1000mg, daily dose 3000mg) or extended release formulations may provide more relief. Non-steroidal anti-inflammatories (ibuprofen) may be more effective for spine-related pain (but have stomach and kidney risks). Non-steroidal anti-inflammatories should be used short-term in lower dose courses with gastrointestinal protection (antacids).

Nerve pain medications (gabapentin and pregabalin) can be used in older persons, with caution to dose and kidney function- start with a lower doses and titrate slowly.

Newer antidepressants (duloxetine) more so than older ones (nortriptyline) can help with spine-related nerve pain, with attention to possible sedation and dizziness.

Some muscle relaxants (baclofen and tizanidine) can be used in older persons, again accounting for kidney and liver function.

Opioids have limited use in common spine-related pain, but can be used with caution in cases that don’t respond to treatment. What should readers take away from your report?

Response: Careful planned use of pain medications in older patients can be helpful, driving by the diagnosis (correct drug for the specific diagnosis) and controlling for decreased metabolism, medical problems, and polypharmacy. With specific recommendations in the paper, and above. What recommendations do you have for future research as a result of this work?

Response: More double-blind, placebo controlled trials that focus on older patients (those >65 years)- a portion of our data was from studies that included older patients- but a more typical mean age of patients in their 50s.

No disclosures


Jonathan L. Fu, Michael D. Perloff. Pharmacotherapy for Spine-Related Pain in Older Adults. Drugs & Aging, 2022; DOI: 10.1007/s40266-022-00946-x


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