Pharmacology for Spine-Related Pain in Older Adults
Michael Perloff, MD, PhD, Director, Neurology Pain Medicine, Boston Medical Center

Rational therapeutic choices should be targeted to spine pain diagnosis, such as NSAIDs and acetaminophen for arthritic and myofascial-based complaints, gabapentinoids or duloxetine for neuropathic and radicular symptoms, antispastic agents for myofascial-based pain, and combination therapy for mixed etiologies.  Some medications may pose increased risk for harm (e.g. sedation and falls with TCAs and muscle relaxants) in older adults, and safe prescribing recommendations include starting at lower dosages with gradual titration, in addition to careful selection based on side effect profile.

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