Some drugs are safer and more effective than others for the treatment of spinal cord injury in older patients, a new general literature review suggests.

Investigators evaluated 138 double-blind, placebo-controlled trials and evaluated evidence of medications used for this purpose in older adults.

One of their main findings and recommendations is: Acetaminophen Non-steroidal anti-inflammatory drugs (NSAIDs) are more effective for spinal cord injury.

However, NSAIDs should be used in small doses in the short term, with caution in the gastrointestinal tract, the researchers said.

Corticosteroids have little evidence to treat non-specific ones. Back painHe added.

“Most seniors experience neck or lower back pain at some point, making it very difficult to see their doctor,” Associate Investigator Michael Perloff, MD, PhD, Department of Neurology, Boston University School of Medicine, Massachusetts, said in a news release.

“Our findings provide a guideline for physicians to use for older people with a history of complex medical conditions,” Perloff added.

The results were. Published online June 27 Medications and Aging.

Tips, warnings

According to researchers, spinal cord injury is becoming more common in the US population.

Medications play an important role in pain relief, but their use is limited in the elderly due to reduced liver and kidney function, associated medical problems, and polyclinics.

Other key findings from the literature review include neuropsychiatric medications Gabapantin And Pregabalin They can cause dizziness or difficulty walking, and have some proven benefits for neck and back nerve pain, e.g. sciaticaIn adults.

These agents should be used in small doses with modifications, the researchers said.

They warn that muscle relaxes Carisoprodol, chlorzoxazone, Cyclobenzaprin, Methacrylon, MetocarbamolAnd orphenadrine They should be avoided by adults due to their association with sedation and the risk of falls.

“Reasonable Medical Choices”

Three other muscle cramps – Tizanidine, BaclofenAnd Dantrol – May be useful for neck and back pain. Too much evidence supports tizanidine and baclofen. These should be used in reduced doses. Typhoid fever should be avoided in patients with liver disease, and in patients with kidney disease, baclofen levels should be reduced, the researchers write.

Other findings include:

  • Old-fashioned tricyclic antidepressants should be avoided because they usually have side effects in this population, but nortriptyline And desipramine Low-grade pain in the neck and back can be treated better.

  • New antidepressants, especially selective serotonin-norepinephrine, are inhibited. DuloxteinHave a better safety profile and better results with spinal cord injury.

  • In the treatment of spinal cord injury in adults, traditional opioids are avoided due to related risks.

However, low-dose opioid therapy may be helpful for severe respiratory illness, close monitoring of patients, the researchers said.

Such as weak opioids Tramadol, Older patients are better able to cope. They work well when combined with acetaminophen, but carry the risk of constipation, stomach cramps and risk. Constipation.

“With the right amount of medication, the right diagnosis, correcting past medical problems will lead to the use of better treatments for back pain,” said co-investigator Jonathan Fu, MD. He said on the release.

“Reasonable treatment options should focus on the diagnosis of spinal pain, such as NSAIDs and acetaminophen for arthritis and myofascial, Gabopentinoids or Duloxetine for neuropathic and radicular symptoms, myofascial-based pain antiseptic agents, and combined treatment for mixed etiologies.” The investigators write.

Medications are also combined with physical therapy and exercise programs, as well as the treatment of underlying malignancies and treatment of underlying diseases – taking into account the need for potential interventions and / or corrective surgery.

The study had no specific financial support. The investigators did not report any related financial transactions.

Drug aging. Published June 27, 2022 online. Draft

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