A warm welcome to new participants in CHAMP’s January Medication Management course! I look forward to supporting you during the course. Please feel free to post any comments or questions about medication management here, and I will respond within a few days.

This week’s guest blogger discussed her experience with CHAMP’s Pain Management Course; Registration will open for April courses soon. Recently I participated on an advisory panel where one of the discussion items was the use of pain medication agents in the geriatric population. The consensus of the multi-disciplinary panelists was that the picture for treating geriatric patients for pain at this point is very muddy due to concerns about APAP dosing, the risk vs. benefit of using NSAIDs and the regulatory climate for opioid use since Michael Jackson’s death.

Several panelists expressed considerable concern about using NSAIDs due to their potential for significant adverse reactions and drug-drug interactions. One emerging interaction we were discussing is the potential for increased risk for upper GI bleeds when SSRI antidepressants (e.g., Paxil®) are taken along with NSAIDs. (A recent analysis concluded that selective serotonin reuptake inhibitor use, alone and in combination with NSAIDs, can substantially increase the risk of upper GI bleeds in the over 50 population.*)

A possible trend away from NSAID use may explain why Vicodin® has become one of the most frequently prescribed medications, particularly for use for acute pain.

What resonated for me about our discussion on the panel is how important an in-home pain assessment and accurate medication inventory is to help patients and providers develop an individualized pain care plan. Unit 4 of the CHAMP Pain Management course focuses on pain care plans, including determining the patient’s own pain goal. You can also find free downloadable tools and resources to improve pain management here.

*Reference: Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs Loke YK, Trivedi AN, Singh S. Aliment Pharmacol Ther 27, 31–40

Dennee Frey, CHAMP Pharmacy Expert