Michele Bellantoni, M.D., Medical Director of Johns Hopkins Bayview Care Center, answers a reader’s question on the safety of narcotic pain medication for chronic arthritis pain.
Q. I prefer ibuprofen over acetaminophen for arthritis pain relief. But now my doctor suggests I take a narcotic pain reliever. Is this safe?
Dr. Bellantoni answers: Although older adults may consider occasional short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs, like aspirin, ibuprofen, and naproxen) and COX-2 inhibitors (Celebrex) for minor aches and pains, the risk of gastrointestinal bleeding, kidney damage, and (with COX-2 inhibitors) heart attack associated with these pain relievers is too great for long-term use. In fact, newly updated guidelines for pain management in older people, published by the American Geriatrics Society (AGS), discourage most people over 75 from taking them.
Many people do find acetaminophen (Tylenol) effective for managing chronic musculoskeletal pain -- and it is considered safe as long as it used as directed. But if it does not help you, your doctor is right: You should consider a narcotic pain reliever such as morphine, oxycodone, hydrocodone, or fentanyl. These drugs do not pose the health risks you face with NSAIDs.
As Michele Bellantoni, M.D., Associate Professor of Medicine, Medical Director of Johns Hopkins Bayview Care Center, and Health After 50 Board Member, points out, “For many older people, the risks of long-term use of NSAIDs and COX-2 inhibitors are more of a concern than the side effects of narcotics. Constipation and drowsiness are the most common of these side effects, and they can usually be managed by working with your doctor to find the optimal dose of medication.”
Sometimes, people who take narcotics abuse them or build up a tolerance, resulting in the need for escalating doses of medication to achieve the same effect. But studies show that abuse is rare among patients with chronic pain, and with newer, long-acting opioids that release controlled amounts of medication into the bloodstream, increasing the dosage usually is not necessary.
