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Editor's Correspondence
June 27, 2011

A Painful Setback: Misinterpretation of Analgesic Safety in Older Adults May Inadvertently Worsen Pain Care

Author Affiliations

Author Affiliations: Department of Emergency Medicine (Drs Hwang and Richardson), Brookdale Department of Geriatrics and Palliative Medicine (Drs Hwang and Morrison), Department of Health Evidence and Policy (Dr Richardson), Mount Sinai School of Medicine, New York, New York; Geriatrics Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York (Dr Morrison); and Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston (Dr Todd).

Arch Intern Med. 2011;171(12):1127. doi:10.1001/archinternmed.2011.262

Observational findings by Solomon et al1 of safety events associated with opioid and nonsteroidal anti-inflammatory drugs (NSAIDs) have made headline news and are now at risk of misinterpretation and potentially worsening overall pain care for older adults. The studies have significant limitations that may preclude the implications investigators and journal editors hope to convey. While propensity scores were used to methodologically adjust for the limitations of Medicare and pharmacy claims data, sizeable confounders, including the severity of pain experienced by subjects, the type of medications used (including over-the-counter analgesics), and more importantly, the dose and duration of medication use could not be accounted for.1 Despite these shortcomings, the results have received considerable attention. The general public and medical communities have been quick to caution against the use of opioids and analgesics in older adults. Alarmist headlines with phrases such as “Narcotic Painkillers” and “Hazards in Elderly” were found in national headlines2-4 and medical Web sites5-7 immediately after results were released.

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