- With Mayo Clinic anesthesiologist
David P. Martin, M.D., Ph.D.
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David P. Martin, M.D., Ph.D.
David P. Martin, M.D., Ph.D.
David P. Martin, M.D., Ph.D., is board certified in anesthesiology by the American Board of Anesthesiology with advanced certification in pain medicine. He is a consultant in the Department of Anesthesiology at Mayo Clinic, Rochester, Minn., and an associate professor of anesthesiology at Mayo Clinic College of Medicine. Dr. Martin, a Cincinnati native, received his M.D. degree, and has a Ph.D. in neuroscience, from Washington University School of Medicine in St. Louis.
He has been with Mayo Clinic since 1993. Dr. Martin, who chaired Mayo Clinic's Division of Pain Medicine in the Department of Anesthesiology from 1999 to 2001, is a member of the International Association for the Study of Pain, the American Pain Society, the American Society of Anesthesiologists, the Minnesota Society of Anesthesiologists and other professional groups. He has been published widely in the medical literature on pain management and related topics.
Definition (1)
- 'Degenerative changes' in the spine: Is this arthritis?
Treatments and drugs (4)
- Arthritis pain: Are opiates safer than NSAIDs for older people?
- Hip resurfacing: An alternative to conventional hip replacement?
- Arthritis pain medications: Do they raise blood pressure?
- see all in Treatments and drugs
Lifestyle and home remedies (3)
- Glucosamine: Does it affect blood sugar?
- MSM for arthritis pain: Is it safe?
- Water exercise for arthritis: Does pool temperature matter?
Alternative medicine (1)
- Glucosamine supplements: Can they rebuild cartilage?
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Question
Arthritis pain: Are opiates safer than NSAIDs for older people?
My mom is 78 and has arthritis pain in her knee. Her doctor wants her to use prescription opiates instead of over-the-counter medications like ibuprofen and naproxen. Is this safe?
Answer
from David P. Martin, M.D., Ph.D.
This is a question of risk versus benefit. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, have traditionally been the first choice for managing arthritis pain. Unfortunately, NSAIDs increase the risk of stomach pain, intestinal bleeding, heart problems and kidney failure.
In light of these risks, the American Geriatrics Society (AGS) recently advised doctors to avoid NSAIDs for pain in older adults whenever possible. Drugs in the NSAID category — including celecoxib (Celebrex), a COX-2 inhibitor — should be used only rarely in older people, according to the AGS.
Morphine, codeine and other opiates may indeed be safer than NSAIDs for older people. The most common side effects of opiates are sedation, nausea and constipation. Although opiates may be habit-forming, this is rarely a problem if taken strictly as directed by your doctor.
One cautionary note: Some common opiate-based prescription drugs, including oxycodone (Percocet) and hydrocodone (Vicodin), are actually a combination of an opiate and acetaminophen, the active ingredient in Tylenol and several other over-the-counter pain relievers and cold remedies.
Although the AGS recommends acetaminophen as a first-line treatment for geriatric pain, the organization also warns that excessive daily doses of the drug can damage the liver. No one should take more than a total of 4 grams of acetaminophen within any 24-hour period.
Next questionHip resurfacing: An alternative to conventional hip replacement?
- AGS clinical practice guideline: Pharmacological management of persistent pain in older persons. New York, N.Y.: American Geriatrics Society. http://www.americangeriatrics.org/education/executive_summary.shtml. Accessed May 19, 2009.
- Pharmacological management of persistent pain in older persons. American Geriatric Society. http://www.americangeriatrics.org/education/final_recommendations.pdf. Accessed May 19, 2009.
- David Martin (expert opinion). Mayo Clinic, Rochester, Minn. May 29, 2009.
