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The Role of Opioid Analgesics in Rheumatoid Disease in the Elderly Population

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Abstract

Adequate pain therapy is an important aspect in the treatment of the elderly patient with rheumatoid disease. Problems with traditional NSAIDs include potentially serious gastrointestinal, cardiovascular and renal adverse effects, especially in the elderly. In addition, the selective cyclo-oxygenase-2 inhibitors have been associated with renal and cardiovascular adverse effects which may limit their use in the elderly with renal or cardiovascular disease.

Opioids provide a treatment option for the management of pain in elderly patients with rheumatoid disease in whom pain control under standard management is poor; however, various therapeutic difficulties are encountered in the heterogenous elderly population (increased risk of adverse effects, multimorbidity, and polypharmacy). Lower initial opioid dosage, prolonged dosage intervals and slower dosage titrations are advisable because of altered pharmacokinetics and pharmacodynamics. Kidney function should be tightly monitored and a timely use of laxatives is to be encouraged.

Randomised clinical studies of opioids in musculoskeletal pain (e.g. osteoarthritis) have increasingly extended the scientific basis for their use. However, no randomised controlled clinical trials have examined the efficacy and the benefit/risk ratio of opioids in rheumatoid arthritis.

Opioids also demonstrate an analgesic effect following local peripheral application. This opens the way to new therapeutic options in the future through the development of systemic peripherally selective opioids without CNS adverse effects.

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No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Anesthesiology, University Erlangen-Nürnberg, Krankenhausstraße 12, Erlangen, 91054, Germany

    Norbert Griessinger

  2. Department of Anesthesiology and Critical Care Medicine, Benjamin Franklin University Hospital, Free University of Berlin, Berlin, Germany

    Reinhard Sittl & Michael Schaefer

  3. Department of Anesthesiology and Intensive Medicine, General Hospital Klagenfurt, Klagenfurt, Austria

    Robert Jost & Rudolf Likar

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Correspondence to Norbert Griessinger.

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Griessinger, N., Sittl, R., Jost, R. et al. The Role of Opioid Analgesics in Rheumatoid Disease in the Elderly Population. Drugs Aging 20, 571–583 (2003). https://doi.org/10.2165/00002512-200320080-00003

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