What medication is recommended for hip pain in an elderly female?

Medication for Hip Pain in an Elderly Female

Start with scheduled acetaminophen 1000 mg every 6 hours (maximum 4 grams daily) as the cornerstone of pain management, avoiding NSAIDs due to their significant risks in elderly patients including renal dysfunction, gastrointestinal bleeding, and cardiovascular complications. 1, 2, 3

First-Line Treatment: Acetaminophen

• Administer acetaminophen 1000 mg orally or intravenously every 6 hours on a scheduled basis (not as-needed) for continuous pain control 4, 2, 3
• This provides effective analgesia without the respiratory depression, delirium, or sedation risks associated with opioids 4, 2
• Acetaminophen is effective for mild-to-moderate pain, particularly for osteoarthritis and musculoskeletal conditions common in elderly females 1, 3
• Never exceed 4 grams in 24 hours, especially when using combination products 2, 3

Why NSAIDs Should Be Avoided

• NSAIDs must be used with extreme caution or avoided entirely in elderly patients due to multiple serious risks 1
• They are contraindicated in patients with renal dysfunction, which is common in elderly populations 1
• NSAIDs significantly increase risk of gastrointestinal bleeding, particularly when combined with anticoagulants or antiplatelet agents like aspirin 1, 5
• Cardiovascular risks increase with longer use, and NSAIDs should never be used in patients with heart disease 5
• If NSAIDs are absolutely necessary despite these risks, use the lowest effective dose for the shortest duration and co-prescribe a proton pump inhibitor 1

Adjunctive Non-Opioid Options

• Consider topical NSAIDs for localized hip osteoarthritis pain as they provide joint-specific relief without systemic side effects 2
• Apply topical lidocaine patches for any neuropathic pain component 2
• Physical therapy should be considered for mild-to-moderate symptomatic hip osteoarthritis before escalating to stronger medications 1

Opioid Use: Last Resort Only

• Reserve opioids strictly for breakthrough pain when acetaminophen and other non-opioid strategies have failed 1, 2, 3
• Use the lowest effective dose for the shortest duration possible 1, 2, 3
• Elderly patients have increased risk of morphine accumulation leading to over-sedation, respiratory depression, and delirium 1, 4, 2
• Avoid codeine entirely as it is constipating, emetic, and associated with postoperative cognitive dysfunction 1
• Tramadol should also be used with caution due to confusion risk and seizure threshold reduction in older patients 1

Critical Pitfalls to Avoid

• 42% of patients over 70 receive inadequate analgesia despite reporting moderate-to-high pain, so systematic pain assessment using numeric rating scale or verbal descriptor scale is essential 4, 2
• Both inadequate analgesia AND excessive opioid use increase the risk of postoperative delirium in elderly patients 2
• Be aware that elderly patients have reduced renal function and altered drug metabolism, requiring careful dose adjustments 2
• Never combine acetaminophen-containing products without tracking total daily dose to prevent inadvertent overdose 2

Special Considerations for Hip Fracture

• If this elderly female has a hip fracture requiring surgery, regular paracetamol administration should continue throughout the perioperative period 1
• Consider peripheral nerve blocks (fascia iliaca compartment block) for hip fractures to reduce opioid requirements 2