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Clinicians aren’t limited when it comes to appropriate drug options for treating spine pain in older patients, according to a new review of medication studies.

Investigators Jonathan Fu and Michael D. Perloff, MD, PhD, of the Boston University School of Medicine, looked at the evidence basis for a wide range of potential drug therapies, zeroing in on drug metabolism and adverse drug reactions in particular. A total of 138 double-blind, placebo-controlled trials were chosen for review.

Spine pain is a common source of discomfort for seniors, but clinicians must balance benefits and risks to geriatric patients when treating the problem with medications, the investigators stressed. Seniors’ reduced liver and kidney function can put them at greater risk of adverse side effects, and polypharmacy is often a concern as well, for example.

The findings included:

  • Strong evidence for nonsteroidal anti-inflammatory drug (NSAIDs) use, if prescribers make adjustments for gastrointestinal and renal risk factors
  • Mixed evidence for the tricyclic antidepressants (TCAs) gabapentin and pregabalin for treating neuropathic pain, and good evidence for the use of serotonin and norepinephrine reuptake inhibitors (SNRIs) for that condition. (SNRIs also had a relatively more favorable safety profile than the TCAs in these cases.)
  • Some evidence for the use of tramadol in older patients, leaning more favorably toward those aged 65 years and younger
  • Evidence that opioids are typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk and are reserved for stubborn, severe pain. 

Detailed findings and recommendations were published in the journal Drugs & Aging.

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