A 75-year-old man with poorly controlled type 2 diabetes, hypertension, and CKD stage 4 (eGFR 25 mL/min/1.73m²) requires analgesia for moderate osteoarthritis pain in his knees. Paracetamol 1g QDS provides insufficient relief. Which analgesic medication should be used with EXTREME caution or avoided according to BNF/NICE guidance?