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The American Geriatrics Society has released new guidelines saying that older patients in moderate and severe pain should be given opiods and only rarely be given NSAIDs and COX-2 selective inhibitors. But in its level of evidence to support this it says:
"All patients with moderate-severe pain, pain-related functional impairment or diminished quality of life due to pain should be considered for opioid therapy." (low quality of evidence, strong recommendation)
Whereas when it comes to side effects it says:"Clinicians should anticipate, assess for, and identify potential opioid-associated adverse effects." (moderate quality of evidence, strong recommendation)
The link to the free guidelines is http://www.americangeriatrics.org/education/final_recommendations.pdf
The guidelines are a triumph of expert opinion over evidence but I'm told by GP colleagues that this is what happens anyway - that the risk of perforation and CV events is stronger than the risk of opiods in this population. So is this what ihappens anyway?