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

  • Gary Ruoff
    Correspondence
    Requests for reprints should be addressed to Gary Ruoff, MD, Westside Family Medical Center, 6565 Main Street, Kalamazoo, Michigan 49009
    Affiliations
    Westside Family Medical Center, Kalamazoo, Michigan, USA
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      Abstract

      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.
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      References

      1. Caudill MA, Holman GH, Turk D. Effective ways to manage chronic pain. Patient Care 1996:154–172.

        • Katz W.A
        Approach to the management of nonmalignant pain.
        Am J Med. 1996; 101: 54S-63S
        • Whelton A
        • Hamilton C.W
        Nonsteroidal anti-inflammatory drugs.
        J Clin Pharmacol. 1991; 31: 588-598
        • Conaway D.C
        Using NSAIDs safely in the elderly.
        Hosp Med. 1995; May: 1-9
        • Kendall B.J
        • Peura D.A
        NSAID-associated gastrointestinal damage and the elderly.
        Practical Gastroenterology. 1993; 17: 13-29
        • Roth S.H
        Nonsteroidal anti-inflammatory drugs.
        Ann Intern Med. 1988; 109: 353-354
        • Gurwitz J.H
        • Avorn J
        • Bonn R.L
        • et al.
        Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy.
        JAMA. 1994; 272: 781-786
        • Henrich W.L
        • Agodoa L.E
        • Barrett B
        • et al.
        Analgesics and the kidney.
        Am J Kidney Dis. 1996; 27: 162-165
        • Pincus T
        • Griffin M
        Gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs.
        Am J Med. 1991; 91: 209-212
        • Henry D
        • Dobson A
        • Turner C
        Variability in the risk of major gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs.
        Gastroenterology. 1993; 105: 1078-1088
        • Allison M.C
        • Howatson A.G
        • Torrance C.J
        • et al.
        Gastrointestinal damage associated with the use of nonsteroidal anti-inflammatory drugs.
        N Engl J Med. 1992; 327: 749-754
        • Barrier C.H
        • Hirschowitz B.I
        Controversies in the detection and management of nonsteroidal anti-inflammatory drug-induced side effects of the upper gastrointestinal tract.
        Arthritis Rheum. 1989; 32: 926-932
        • Griffin M.R
        • Piper J.M
        • Daugherty J.R
        • et al.
        Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons.
        Ann Intern Med. 1991; 114: 257-263
        • Levy M
        • Miller D.R
        • Kaufman D.W
        • et al.
        Major upper gastrointestinal tract bleeding. Relation to the use of aspirin and other non-narcotic analgesics.
        Arch Intern Med. 1988; 148: 281-285
        • Yost J.H
        • Morgan Jr, C.J
        Cardiovascular effects of NSAIDs.
        J Musculoskel Med. 1994; 11: 22-34
        • Benson G.D
        Hepatotoxicity following the use of antipyretic analgesics.
        Am J Med. 1983; 75: 85-93
        • Pope J.E
        • Anderson J.J
        • Felson D.T
        A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure.
        Arch Intern Med. 1993; 153: 477-484
        • Johnson A.G
        • Nguyen T.V
        • Day R.O
        Do nonsteroidal anti-inflammatory drugs affect blood pressure?.
        Ann Intern Med. 1994; 121: 289-300
        • Weissmann G
        NSAIDs.
        in: Wyngaarden J.B Smith L.H Bennett J.C Cecil Textbook of Medicine. 19th ed. WB Saunders, Philadelphia1995: 114-118
        • Bjorkman D.J
        Nonsteroidal anti-inflammatory drug-induced gastrointestinal injury.
        Am J Med. 1996; 101: 25S-32S
        • Hochberg M.D
        • Altman R.D
        • Clark B.M
        • et al.
        Guidelines for the medical management of osteoarthritis.
        Arthritis Rheum. 1995; 38: 1535-1546
        • Ameer B
        • Greenblatt D.J
        Acetaminophen.
        Ann Intern Med. 1977; 87: 202-209
        • Strom B.L
        Adverse reactions to over-the-counter analgesics taken for therapeutic purposes.
        JAMA. 1994; 272: 1866-1867
        • Gibson T.P
        Pharmacokinetics, efficacy, and safety of analgesia with a focus on tramadol HCI.
        Am J Med. 1996; 101: 47S-53S
      2. Dalgin P. Comparison of tramadol and ibuprofen for the chronic pain of osteoarthritis. (Abstr.) Presented at American College of Rheumatology, Washington, DC; November 8-12, 1997.

        • Katz W.A
        The role of tramadol in the management of musculoskeletal pain.
        Today’s Ther Trends. 1995; 13: 177-186
        • Barkin R.L
        Alternative dosing for tramadol aids effectiveness.
        Formulary. 1995; 30: 542-543
        • Gloth III, F.M
        Concerns with chronic analgesic therapy in elderly patients.
        Am J Med. 1996; 101: 19S-24S
      3. Tollison JW. Special considerations in pharmacologic pain management. Handbook of Pain Management. 2nd ed. Baltimore: Williams and Wilkins 1994:215–223.

        • Berndt S
        • Maier C
        • Schütz H.W
        Polymedication and medication compliance in patients with chronic nonmalignant pain.
        Pain. 1993; 52: 331-339