Management of Chronic Shoulder Pain in Elderly Patients with Comorbidities

Introduction to Safer Alternatives

• The American College of Physicians recommends investigating the etiology and severity of elevated liver function tests before considering any hepatically metabolized medications, such as prednisone, in a 75-year-old patient with chronic shoulder pain 1
• The American Geriatrics Society suggests quantifying chronic kidney disease stage by obtaining an estimated glomerular filtration rate to precisely stage kidney disease in elderly patients with mild CKD 5

First-Line Approach for Chronic Shoulder Pain

• The American Academy of Family Physicians recommends starting with acetaminophen, 500-1000 mg every 6-8 hours as needed, with a maximum of 3g/day in elderly patients with liver concerns, for the management of chronic shoulder pain 1
• The American College of Rheumatology suggests referring patients to physical therapy for evidence-based shoulder rehabilitation as the cornerstone of chronic shoulder pain management 4

Inflammatory Conditions and Corticosteroid Use

• The American College of Rheumatology recommends reserving systemic corticosteroids for confirmed inflammatory conditions, such as inflammatory arthritis with objective findings, polymyalgia rheumatica, or acute inflammatory conditions with severe functional impairment 2, 3, 4
• The National Kidney Foundation advises against using corticosteroids for non-inflammatory musculoskeletal pain, as they provide minimal benefit and substantial harm in this context 3