Cox-2 inhibitors and other nonsteroidal anti-inflammatory drugs in the treatment of pain in the elderly

NSAIDs are among the most commonly prescribed class of drugs in the elderly population. They are effective in treating mild to moderately severe pain and inflammation and can be used to treat a wide variety of conditions. In the treatment of severe pain, the addition of an NSAID can reduce narcotic requirements and the side effects of opioid analgesia. NSAIDs are associated with several mechanism-based adverse effects, especially GI toxicity, which can limit therapy in the elderly. COX-2 inhibitors are a major advance in the treatment of pain in the elderly population. COX-2 inhibitors significantly reduce the risk of both common (dyspepsia) and severe (perforations, obstructions and GI bleeds) GI adverse events compared with NSAIDs. Renal effects, however, are not diminished with coxibs; high-risk patients should be carefully monitored when NSAIDs or coxibs are administered. Results of ongoing clinical trials will help to determine if coxibs offer protection against GI malignancies or Alzheimer's disease.