Persistent pain in the older adult

795 Introduction The recent publication of revised guidelines for the management of persistent pain in the older adult (American Geriatrics Society [AGS], 2009) has posed a dilemma for clinicians. In essence, these revised guidelines now down‐ play the use of nonsteroidal anti‐inflammatory drugs (NSAIDs) relative to prior year’s recom‐ mendations. Whereas NSAIDs have traditional‐ ly occupied a prominent role in the treatment of such conditions as osteoarthritis (OA) and low back pain, the AGS has called attention to the sig‐ nificant morbidity and mortality associated with their use in patients over the age of 65. Throughout human history, these agents have been used for their analgesic and antipyretic prop‐ erties. Ancient Greeks were known to chew bark from willow trees, which was later found to con‐ tain salicin, a precursor to salicylate. By the 1900s, salicylic acid was made into pill form, now known as aspirin. In more recent times, many other agents were discovered with similar properties, and the initialism, NSAIDs, was created.1,2 Over 30 million people use NSAIDs world‐ wide. The most common rheumato logical disor‐ der treated with this class of therapeutic agents is OA, which increases in prevalence with age.3 Debility from OA may result in more sedentary, less productive lifestyles, and may contribute to missed work. Compound this issue with the high prevalence of low back pain, and it can be readi‐ ly appreciated that healthcare providers treating older adults commonly confront chronic pain in their outpatient practices. Before proceeding, it is important to empha‐ size that the AGS recommendations address man‐ agement of only noninflammatory, noncancer pain, and only in patients older than 65 years (e.g., rheumatoid arthritis is excluded). Discus‐ sion is also limited to standard medical prac‐ tice, and therefore complementary alternative medicine, herbal remedies, parenteral anesthetic agents, neurostimulatory pump techno logies, bio‐ feedback, and psycho logical inter ventions were not of relevance. In like manner, these topics are beyond the scope of our present discourse.