Prescribing analgesics. How to improve function and avoid toxicity when treating chronic pain.

Analgesic drugs are used more often than nondrug therapies for the treatment of pain in older patients. Despite the risk of adverse reactions, analgesics can be used safely for chronic pain in older patients when physicians prescribe with care. Nonopoid analgesics include acetaminophen, aspirin, NSAIDs, and COX-2 inhibitors. Opoid analgesics may be useful, but they should be continued only if side effects can be controlled and the patient demonstrates improved function. Adjuvant medications include antidepressants, anticonvulsants, neuroleptics, and oral membrane stabilizers. Benzodiazepines may be harmful in older patients, and muscle relaxants tend to be overused. Topical agents may be useful for certain neuropathic pain conditions.