From the Research
For moderate to severe degenerative disc disease (DDD) in an 87-year-old patient, I recommend starting with conservative management including acetaminophen (up to 3000mg daily in divided doses) for pain control and physical therapy focusing on gentle core strengthening and flexibility. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of balancing pain management with the risk of medication side effects and complications in elderly patients 1. Key considerations in managing DDD in elderly patients include:
- Using NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-500mg twice daily) for short periods during pain flares, but with caution due to increased risk of GI bleeding, renal impairment, and cardiovascular events in elderly patients.
- Utilizing topical analgesics such as lidocaine patches or diclofenac gel for localized relief with fewer systemic side effects.
- Considering tramadol 50mg every 6 hours as needed (maximum 300mg daily) for short-term use in more severe pain, while being aware of its potential for cognitive and opioid-like side effects.
- Using muscle relaxants like cyclobenzaprine 5mg at bedtime for associated muscle spasms, but with caution due to potential excessive sedation in elderly patients.
- Employing assistive devices such as a cane or walker to improve mobility and stability. Surgical interventions should be considered only if conservative measures fail and quality of life is significantly impacted, weighing carefully against the increased surgical risks at advanced age 1. It's also important to note that opioids are typically avoided in the treatment of spine-related pain in older adults due to their morbidity and mortality risk and are reserved for refractory severe pain 1. Overall, the goal is to optimize pain management while minimizing risks and complications, prioritizing the patient's quality of life and functional ability.