A Practical Approach to Using Adjuvant Analgesics in Older Adults

Russell K. Portenoy, MD


J Am Geriatr Soc. 2020;68(4):691-698. 

In This Article

Drugs Used for Musculoskeletal Disorders

Common musculoskeletal pains, such as multifocal joint pain and low back pain, are highly prevalent in older adults. The multipurpose adjuvant analgesics that could potentially be used for these disorders include antidepressants, tizanidine, cannabinoids, and botulinum toxin. Although a group of drugs known as so-called muscle relaxants, including methocarbamol, carisoprodol, chlorzoxazone, metaxalone, and cyclobenzaprine, are approved for acute musculoskeletal pain in the United States, they do not directly relax skeletal muscle and have no evidence of efficacy in chronic pain.[65] Given the potential for adverse effects in older adults, these drugs are not favored for chronic pain.

Muscle pain occurs with fibromyalgia and chronic widespread pain, and when severe enough to interfere with quality of life, pharmacotherapy should be considered. Evidence-based guidelines support trials of the analgesic antidepressants, particularly duloxetine and TCAs, and the gabapentinoids, particularly pregabalin.[66]