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Pharmacological Treatments for Persistent Non-Malignant Pain in Older Persons

  • Therapy In Practice
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Abstract

Persistent non-malignant pain is common, often neglected and under-treated among older persons. Some older adults do not complain because they consider chronic pain to be a characteristic of normal aging. Physicians have concerns regarding adverse effects of pharmacological treatment.

The model of the World Health Organization for treatment of cancer pain is generally accepted and also recommended for persistent non-cancer pain. Furthermore, non-pharmacological treatment should complement drug treatment whenever possible. An initial assessment and possible treatment of underlying causes of pain are pertinent.

Modern pharmacological pain management is based on non-opioid and opioid analgesics. NSAIDs are among the most widely prescribed class of drugs in the world. The new cyclo-oxygenase-2 inhibitors such as celecoxib and rofecoxib offer an alternative for the treatment of mild-to-moderate pain in patients with a history of gastric ulcers or bleeding. Paracetamol (acetaminophen) is being used widely for the management of mild pain across all age groups as it has moderate adverse effects at therapeutic dosages.

For moderate pain, a combination of non-opioid analgesics and opioid analgesics with moderate pain relief properties (e.g. oxycodone, codeine, tramadol and tilidine/naloxone) is recommended. For severe pain, a combination of non-opioid analgesics and opioid analgesics with strong pain relief properties (e.g. morphine, codeine) is recommended.

The least toxic means of achieving systemic pain relief should be used. For continuous pain, sustained-release analgesic preparations are recommended. Drugs should be given on a fixed time schedule, and possible adverse effects and interactions should be carefully monitored. Adjuvant drugs, such as antidepressants or anticonvulsants, can be very effective especially in the treatment of certain types of pain, such as in diabetic neuropathy. Effective pain management should result in decreased pain, increased function and improvement in mood and sleep.

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References

  1. Helme RD, Gibson SJ. Pain in older people. In: Crombie IK, Croft PR, Linton SJ, et al., editors. Epidemiology of pain. Seattle: IASP Press, 1996: 103–12

    Google Scholar 

  2. Nikolaus T. Assessment of chronic pain in the elderly [in German]. Ther Umsch 1997; 54: 340–4

    PubMed  CAS  Google Scholar 

  3. Gagliese L, Melzack R. Age differences in the quality of chronic pain: a preliminary study. Pain Res Manag 1997; 2: 157–62

    Google Scholar 

  4. Crook J, Rideout E, Browne G. The prevalence of pain complaints in a general population. Pain 1984; 18: 299–314

    Article  PubMed  CAS  Google Scholar 

  5. Brattberg G, Parker MG, Thorslund M. A longitudinal study of pain: reported pain from middle age to old age. Clin J Pain 1997; 13: 144–9

    Article  PubMed  CAS  Google Scholar 

  6. Badley EM, Tennat A. Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire, United Kingdom. Ann Rheum Dis 1992; 51: 366–71

    Article  PubMed  CAS  Google Scholar 

  7. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995; 38: 19–28

    Article  PubMed  CAS  Google Scholar 

  8. Sternbach RA. Survey of pain in the United States: the Nuprin pain report. Clin J Pain 1986; 2: 49–53

    Article  Google Scholar 

  9. Andersson HI, Ejilertsson G, Leden I, et al. Chronic pain in a geographically defined population: studies of differences in age, gender, social class and pain localization. Clin J Pain 1993; 9: 174–82

    Article  PubMed  CAS  Google Scholar 

  10. Cooner E, Amorosi S. The study of pain in older Americans. New York: Louis Harris and Associates, 1997

    Google Scholar 

  11. Roy R, Thomas M. A survey of chronic pain in an elderly population. Can Fam Physician 1986; 32: 513–6

    PubMed  CAS  Google Scholar 

  12. Roy R, Thomas MR. Elderly persons with and without pain: a comparative study. Clin J Pain 1987; 3: 102–6

    Article  Google Scholar 

  13. Brattberg G, Parker MG, Thorslund M. The prevalence of pain among the oldest old in Sweden. Pain 1996; 67: 29–34

    Article  PubMed  CAS  Google Scholar 

  14. Brochet B, Michel P, Barberger-Gateau P, et al. Population-based study of pain in elderly people: a descriptive survey. Age Ageing 1998; 27: 279–84

    Article  Google Scholar 

  15. Ferrell BA, Ferrell BR, Osterweil D. Pain in the nursing home. J Am Geriatr Soc 1990; 38: 409–14

    PubMed  CAS  Google Scholar 

  16. Scudds RJ, Robertson JM. Empirical evidence of the association between the presence of musculoskeletal pain and physical disability in community-dwelling senior citizens. Pain 1998; 75: 229–35

    Article  PubMed  CAS  Google Scholar 

  17. Casten RJ, Parmelee PA, Kleban MH, et al. The relationships among anxiety, depression, and pain in a geriatric institutionalized sample. Pain 1995; 61: 271–6

    Article  PubMed  CAS  Google Scholar 

  18. Parmelee PA, Katz IR, Lawton MP. The relation of pain to depression among instituionalized aged. J Gerontol 1991; 46: P15–21

    Article  PubMed  CAS  Google Scholar 

  19. Williamson GM, Schulz R. Pain, activity restriction, and symptoms of depression among community-residing adults. J Gerontol 1992; 47: 367–72

    Article  Google Scholar 

  20. Magni G, Caldieron C, Rigatti-Luchini S, et al. Chronic musculoskeletal pain and depressive symptoms in the general population: an analysis of the 1st National Health and Nutrition Examination Survey data. Pain 1990; 43: 299–307

    Article  PubMed  CAS  Google Scholar 

  21. Lichtenstein MJ, Dhanda R, Cornell JE, et al. Disaggregating pain and its effect on physical functional limitations. J Gerontol 1998; 53: M361–71

    CAS  Google Scholar 

  22. Helme RD, Katz B, Gibson SJ, et al. Multidisciplinary pain clinics for older people: do they have a role? Clin Geriatr Med 1996; 12: 563–82

    PubMed  CAS  Google Scholar 

  23. Blyth FM, March LM, Brnabic AJ, et al. Chronic pain in Australia: a prevalence study. Pain 2001; 89: 127–34

    Article  PubMed  CAS  Google Scholar 

  24. Mantyselka P, Kumpusalo E, Ahonen R, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain 2001; 89: 175–80

    Article  PubMed  CAS  Google Scholar 

  25. Lavsky-Shulan M, Wallace RB, Kohout FJ, et al. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc 1985; 33: 23–8

    PubMed  CAS  Google Scholar 

  26. Sengstaken EA, King SA. The problem of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc 1994; 41: 541–4

    Google Scholar 

  27. Ferrell BA, Ferrell BR, Rivera I. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995; 10: 591–8

    Article  PubMed  CAS  Google Scholar 

  28. Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. SAGE Study Group (Systematic Assessment of Geriatric Drug Use via Epidemiology). JAMA 1998; 279: 1877–82

    Article  PubMed  CAS  Google Scholar 

  29. Weiner D, Peterson B, Ladd K, et al. Pain in nursing home residents: an exploration of prevalence, staff perspectives and practical aspects of measurement. Clin J Pain 1999; 15: 92–101

    Article  PubMed  CAS  Google Scholar 

  30. Weiner D, Peterson B, Logue P, et al. Predictors of pain selfreport in nursing home residents. Aging Clin Exp Res 1998; 10: 411–20

    CAS  Google Scholar 

  31. Feldt KS, Ryden MB, Miles S. Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture. J Am Geriatr Soc 1998; 46: 1079–85

    PubMed  CAS  Google Scholar 

  32. Farrell MJ, Katz B, Helme RD. The impact of dementia on the pain experience. Pain 1996; 67: 612–9

    Article  Google Scholar 

  33. Duggleby W, Lander J. Cognitive status and postoperative pain: older adults. J Pain Symptom Manage 1994; 9: 19–27

    Article  PubMed  CAS  Google Scholar 

  34. Marzinski LR. The tragedy of dementia: clinically assessing pain in the confused, nonverbal elderly. J Gerontol Nurs 1991; 17: 25–8

    PubMed  CAS  Google Scholar 

  35. Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995; 123: 195–204

    PubMed  CAS  Google Scholar 

  36. Cutler RB, Fishbain DA, Rosomoff RS, et al. Outcomes in treatment of pain in geriatric and younger age groups. Arch Phys Med Rehabil 1994; 75: 457–64

    Article  PubMed  CAS  Google Scholar 

  37. Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clin Geriatr Med 2001; 17: 433–56

    Article  PubMed  CAS  Google Scholar 

  38. Chakour MC, Gibson SJ, Bradbeer M, et al. The effect of age on A-delta and C-fibre thermal pain perception. Pain 1996; 64: 143–52

    Article  PubMed  CAS  Google Scholar 

  39. Sorkin BA, Rudy TE, Hanlon RB, et al. Chronic pain in old and young patients: differences appear less important than similarities. J Gerontol 1990; 45: P64–8

    Article  PubMed  CAS  Google Scholar 

  40. Gibson SJ, Voukelatos X, Ames D, et al. An examination of pain perception and cerebral event-related potentials following carbon dioxide laser stimulation in patients with Alzheimer’s disease and age-matched control volunteers. Pain Res Manag 2001; 6: 126–32

    PubMed  CAS  Google Scholar 

  41. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons: American Geriatrics Society. J Am Geriatr Soc 2002; 50: S205–24

    Article  Google Scholar 

  42. Feldt KS, Warne MA, Ryden MB. Examining pain in aggressive cognitively impaired older adults. J Gerontol Nurs 1998; 24: 14–22

    PubMed  CAS  Google Scholar 

  43. Grossberg GT, Sherman LK, Fine PG. Pain and behavioural disturbancies in the cognitively impaired older adult: assessment and treatment issues. Ann Long Term Care 2000; 8: 22–4

    Google Scholar 

  44. Miller J, Neelon V, Dalton J, et al. The assessment of discomfort in elderly confused patients: a preliminary study. J Neurosci Nurs 1996; 28: 175–82

    Article  PubMed  CAS  Google Scholar 

  45. Weiner D, Hanlon J. Pain in nursing home residents: management strategies. Drugs Aging 2001; 18: 13–29

    Article  PubMed  CAS  Google Scholar 

  46. Won A, Lapane K, Gambassi G, et al. Correlates and management of nonmalignant pain in the nursing home. J Am Geriatr Soc 1999; 47: 936–42

    PubMed  CAS  Google Scholar 

  47. Ferrell BA. Pain evaluation and management in the nursing home. Ann Intern Med 1995; 123: 681–7

    PubMed  CAS  Google Scholar 

  48. AGS Panel on Chronic Pain in Older Persons. The management of chronic pain in older persons: American Geriatrics Society. J Am Geriatr Soc 1998; 46: 635–51

    Google Scholar 

  49. Melzack R, Katz J. The McGill Pain Questionnaire: appraisal and current status. In: Turk DC, Melzack R, editors. Handbook of pain assessment. New York: Guilford Press, 1992: 152–68

    Google Scholar 

  50. Briggs M, Closs JS. A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopaedic patients. J Pain Symptom Manage 1999; 18: 438–46

    Article  PubMed  CAS  Google Scholar 

  51. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994; 23: 129–38

    PubMed  CAS  Google Scholar 

  52. Gloth FM, Scheve AA, Stober BS, et al. The functional pain scale: reliability, validity and responsiveness in an elderly population. J Am Med Dir Assoc 2001; 2: 110–4

    Article  PubMed  Google Scholar 

  53. Scherder EJ, Bouma A. Visual analogue scales for pain assessment in Alzheimer’s disease. Gerontology 2000; 46: 47–53

    Article  PubMed  CAS  Google Scholar 

  54. Wynne CF, Ling SM, Remsburg R. Comparison of pain assessment intruments in cognitively intact and cognitively impaired nursing home residents. Geriatr Nurs 2000; 21: 20–3

    Article  PubMed  CAS  Google Scholar 

  55. Huskisson EC. Measurement of pain. Lancet 1974; II: 1127–31

    Article  Google Scholar 

  56. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986; 27: 117–26

    Article  PubMed  CAS  Google Scholar 

  57. Herr KA, Mobily PR. Comparison of selected pain assessment tools for use with the elderly. Appl Nurs Res 1993; 6: 39–46

    Article  PubMed  CAS  Google Scholar 

  58. Herr KA, Mobily PR, Kohout FJ, et al. Evaluation of the faces pain scale for the use with the elderly. Clin J Pain 1998; 14: 29–38

    Article  PubMed  CAS  Google Scholar 

  59. Roland M, Morris R. A study of the natural history of back pain: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983; 8: 141–4

    Article  PubMed  CAS  Google Scholar 

  60. Chibnall JT, Tait RC. Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain 2001; 92: 173–86

    Article  PubMed  CAS  Google Scholar 

  61. Weiner D, Pieper C, Mc Connell E, et al. Pain measurement in elders with chronic low back pain: traditional and alternative approaches. Pain 1996; 67: 461–7

    Article  PubMed  CAS  Google Scholar 

  62. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987; 30: 191–7

    Article  PubMed  CAS  Google Scholar 

  63. Herr KA, Mobily PR. Complexities of pain assessment in the elderly: clinical considerations. J Gerontol Nurs 1991; 17: 12–9

    PubMed  CAS  Google Scholar 

  64. Cook AJ. Cognitive-behavioural pain management for elderly nursing home residents. J Gerontol 1998; 53: P51–9

    CAS  Google Scholar 

  65. Johnson M, Ashton CH, Thompson JW. An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS): implications for clinical use of TENS. Pain 1991; 44: 221–9

    Article  PubMed  CAS  Google Scholar 

  66. Kost RG, Strauss SE. Postherpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med 1996; 335: 32–42

    Article  PubMed  CAS  Google Scholar 

  67. Weiner DK, Rudy TE, Glick RM, et al. Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back in older adults. J Am Geriatr Soc 2003; 51: 599–608

    Article  PubMed  Google Scholar 

  68. American Geriatrics Society Panel on Exercise and Osteoarthritis. Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. J Am Geriatr Soc 2001; 49: 808–23

    Article  Google Scholar 

  69. Ettinger WH, Burns R, Messier SP, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997; 277: 25–31

    Article  PubMed  Google Scholar 

  70. Kanis JA. Osteoporis. Oxford: Blackwell Science Ltd, 1994

    Google Scholar 

  71. Ferrell BA, Josepheson KR, Pollan AM, et al. A randomized trial of walking versus physical methods for chronic pain management. Aging Clin Exp Res 1997; 9: 99–105

    CAS  Google Scholar 

  72. Ferrell BR. Patient education and non-drug intervention. In: Ferrell BR, Ferrell BA, editors. Pain in the elderly. Seattle: IASP Press, 1996: 35–44

    Google Scholar 

  73. Keefe FJ, Caldwell DS, Queen KT, et al. Pain coping strategies in osteoarthritis patients. J Consult Clin Psychol 1987; 55: 208–12

    Article  PubMed  CAS  Google Scholar 

  74. Keefe FJ, Williams DA. A comparison of coping strategies in chronic pain patients in different age groups. J Gerontol 1990; 45: P161–5

    Article  PubMed  CAS  Google Scholar 

  75. Wright D, Barrow S, Fisher AD, et al. Influence of physical, psychological and behavioral factors on consultations for back pain. Br J Rheumatol 1995; 34: 156–61

    Article  PubMed  CAS  Google Scholar 

  76. Ferrell BR, Rhiner M, Ferrell BA. Development and implementation of a pain education program. Cancer 1993; 72: 3426–32

    Article  PubMed  CAS  Google Scholar 

  77. Hirano PC, Laurent DD, Lorig K. Arthritis patient education studies, 1987–1991: a review of the literature. Patient Educ Couns 1994; 24: 9–54

    Article  PubMed  Google Scholar 

  78. Weinberger M, Tierney WM, Booher P, et al. Can the provision of information to patients with osteoarthitis improve functional status?: a randomized controlled trial. Arthritis Rheum 1989; 32: 1577–83

    Article  PubMed  CAS  Google Scholar 

  79. Taal E, Rasker JJ, Wiegman O. Group education for rheumatoid arthritis patients. Semin Arthritis Rheum 1997; 26: 805–16

    Article  PubMed  CAS  Google Scholar 

  80. Mazzuca SA, Brandt KD, Katz BP, et al. Effects of self-care education on health status of inner-city patients with osteoarthritis. Arthritis Rheum 1997; 40: 1466–74

    Article  PubMed  CAS  Google Scholar 

  81. LeFort SM, Gray-Donald K, Rowat KM, et al. Randomized controlled trial of community-based psychoeducation program for the self-management of chronic pain. Pain 1998; 74: 297–306

    Article  PubMed  CAS  Google Scholar 

  82. Rakel B, Barr JO. Physical modalities in chronic pain management. Nurs Clin North Am 2003; 38: 477–94

    Article  PubMed  Google Scholar 

  83. Abbot NC, Harkness EF, Stevinson C, et al. Spiritual healing as a therapy for chronic pain: a randomized, clinical trial. Pain 2001; 91: 79–89

    Article  PubMed  CAS  Google Scholar 

  84. Braverman DL, Ericken JJ, Shah RV, et al. Interventions in chronic pain management: complementary techniques. Arch Phys Med Rehabil 2003; 84: S45–9

    Article  PubMed  Google Scholar 

  85. World Health Organisation. Cancer pain relief with a guide to opioid availability. 2nd ed. Geneva: WHO, 1996

    Google Scholar 

  86. Portenoy RK. Opiod therapy for chronic non-malignant pain: current status. In: Fields HI, Libeskind JC, editors. Progress in pain research and management. Seattle: IASP Press, 1994: 247–88

    Google Scholar 

  87. Porter J, Jick H. Addiction rare in patients treated with narcotics [letter]. N Engl J Med 1980; 302: 123

    PubMed  CAS  Google Scholar 

  88. Forman WB. Opioid analgesic drugs in the elderly. Clin Geriatr Med 1996; 12: 489–500

    PubMed  CAS  Google Scholar 

  89. Fine PG. Opioid analgesic drugs in older people. Clin Geriatr Med 2001; 17: 479–87

    Article  PubMed  CAS  Google Scholar 

  90. Max MB, Payne R, Edwards WT, et al. Principles of analgesic drug use in the treatment of acute pain and cancer pain. 4th ed. Glenville II: American Pain Society, 1999

    Google Scholar 

  91. Nikolaus T. Chronic pain must not simply be accepted: which analgesic for which patient? [in German]. MMW Fortschr Med 2000; 142: 968–72

    Google Scholar 

  92. World Health Organisation. Cancer pain relief and palliative care: report of a WHO expert committee. Geneva, Switzerland: WHO, 1990

    Google Scholar 

  93. Gordon DB. Pain management in the elderly. J Perianaesth Nurs 1999; 14(6): 367–72

    Article  CAS  Google Scholar 

  94. Phillips AC, Polisson RP, Simon LS. NSAIDs and the elderly: toxicity and economic implications. Drugs Aging 1997; 10(2): 119–30

    Article  PubMed  CAS  Google Scholar 

  95. Murray MD, Brater DC. Nonsteroidal anti-inflammatory drugs. Clin Geriatr Med 1990; 6: 365–441

    PubMed  CAS  Google Scholar 

  96. Bell GM, Schnitzer TJ. COX-2 Inhibitors and other nosteroidal anti-inflammatory drugs in the treatment of pain in the elderly. Clin Geriatr Med 2001; 17(3): 489–502

    Article  PubMed  CAS  Google Scholar 

  97. Fu JY, Masferrer JL, Seibert K. The induction and suppression of prostaglandin H2 synthase (cyclooxygenase) in human monocytes. J Biol Chem 1990; 265: 16737–40

    PubMed  CAS  Google Scholar 

  98. Crofford L, Lipsky P, Brooks P, et al. Basic biology and clinical application of specific cyclooxigenase-2 inhibitors. Arthritis Rheum 2000; 43(1): 4–13

    Article  PubMed  CAS  Google Scholar 

  99. Whelton A, Fort JG, Puma JA, et al. Cyclooxigenase-2-specific inhibitors and cardiorenal function: a randomized, controlled trial of celecoxib and rofecoxib in older hypertensive osteoarthritis patients. Am J Ther 2001; 8(2): 85–95

    Article  PubMed  CAS  Google Scholar 

  100. Brune K, Hinz B, Zeilhofer HU. Rational basis for the use of non-steroidal antiinflammatory drugs (and selective COX-2 inhibitors) [in German, abstract in English]. Akt Rheumatol 1999; 24: 102–8

    Article  Google Scholar 

  101. Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 2000; 343: 1520–8

    Article  PubMed  CAS  Google Scholar 

  102. Thomas J, Straus WL, Bloom BS. Over-the-counter non-steroidal anti-inflammatory drugs and risk of gastrointestinal symptoms. Am J Gastroenterol 2002; 97(9): 2159–61

    Article  Google Scholar 

  103. Monti DA, Kunkel EJS. Management of chronic pain among elderly patients. Psychiatr Serv 1998; 49(12): 1537–9

    PubMed  CAS  Google Scholar 

  104. Recognition of chronic pain in elderly patients [editorial]. Trauma 2001; 43(3): 1–3, 6

    Google Scholar 

  105. Rainsford KD, Schweitzer A, Brune K. Autoradiographic and biochemical observations on the distribution of non-steroid anti-inflammatory drugs. Arch Int Pharmacodyn Ther 1981; 250: 180–94

    PubMed  CAS  Google Scholar 

  106. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. Ann Intern Med 1991; 115: 787–96

    PubMed  CAS  Google Scholar 

  107. Henry D, Lim LL, Garcia Rodriguez LA, et al. Variability in risk of gastrointestinal complications with individual nonsteroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996 Jun; 312: 1563–6

    Article  PubMed  CAS  Google Scholar 

  108. Shimp LA. Safety issues in the pharmacologic management of chronic pain in the elderly. Pharmacotherapy 1998; 18(6): 1313–22

    PubMed  CAS  Google Scholar 

  109. AGS Panel on Chronic Pain in Older Persons. The management of chronic pain in older persons. Geriatrics 1998 Oct; 53Suppl. 3: S8–S24

    Google Scholar 

  110. Brune K, Beyer A, Schäfer M. Schmerz [in german]. Berlin: Springer-Verlag, 2001

    Book  Google Scholar 

  111. Lapane KL, Spooner JJ, Mucha L, et al. Effect of nonsteroidal anti-inflammatory drug use on the rate of gastrointestinal hospitalizations among people living in long-term care. J Am Geriatr Soc 2001; 49: 577–84

    Article  PubMed  CAS  Google Scholar 

  112. Langman MJS, Weil J, Wainwright P, et al. Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994; 343: 1075–8

    Article  PubMed  CAS  Google Scholar 

  113. Andrade SE, Martinez C, Walker AM. Comparative safety evaluation of non-narcotic analgesics. J Clin Epidemiol 1998 Dec; 51(12): 1357–65

    Article  PubMed  CAS  Google Scholar 

  114. Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving non-steroidal anti-inflammatory drugs. Ann Intern Med 1995; 123: 241–9

    PubMed  CAS  Google Scholar 

  115. Workman BS. Management of chronic pain in older people. Aust J Hosp Pharm 1998; 28(5): 361–7

    Google Scholar 

  116. Hawkey CJ, Karrasch JA, Szczepanski L, et al. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1998; 338: 727–34

    Article  PubMed  CAS  Google Scholar 

  117. Chan FKL, Hung LCT, Suen BY, et al. Celecoxib versus diclofenac and omeprozole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 2002 Dec; 347: 2104–10

    Article  PubMed  CAS  Google Scholar 

  118. Meyer UA. Metabolic interaction of the proton pump inhibitors lansoprazole, omeprazole and pantoprazole with other drugs. Eur J Gastroenterol Hepatol 1996; 8Suppl. 1: S21–5

    Article  PubMed  Google Scholar 

  119. Chawla PS, Kochar MS. Effect of pain and nonsteroidal analgesics on blood pressure. WMJ 1999 Sep–Oct; 98(6): 22–25

    PubMed  CAS  Google Scholar 

  120. Johnson AG, Nguyen TV, Day RO. Do nonsteroidal antiinflammatory drugs affect blood pressure? A metaanalysis. Ann Intern Med 1994; 121: 289–300

    PubMed  CAS  Google Scholar 

  121. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of ontensive blood-pressure lowering and low-dose aspirin in patients with hypertension: pricipal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998 Jun 13; 351(9118): 1755–62

    Article  PubMed  CAS  Google Scholar 

  122. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13

    Article  Google Scholar 

  123. Griffin MR, Yared A, Ray WA. Nonsteroidal anti-inflammatory drugs and acute renal failure in elderly persons. Am J Epidemiol 2000 Mar; 151: 488–96

    Article  PubMed  CAS  Google Scholar 

  124. Epstein M. Non-steroidal anti-inflammatory drugs and the continuum of renal dysfunction. J Hypertens 2002 Sep; 20Suppl. 6: S17–23

    CAS  Google Scholar 

  125. Perneger TV, Whelton PK, Klag MJ. Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. N Engl J Med 1994; 331: 1675–9

    Article  PubMed  CAS  Google Scholar 

  126. Fored MC, Ejerblad E, Lindblad P, et al. Acetaminophen, aspirin and chronic renal failure. N Engl J Med 2001; 345: 1801–8

    Article  PubMed  CAS  Google Scholar 

  127. Brater DC. Anti-inflammatory agents and renal function. Semin Arthritis Rheum 2002 Dec; 32 (3 Suppl. 1): 33–42

    Article  PubMed  CAS  Google Scholar 

  128. Furst DE. Are there differences among nonsteroidal antiinflammatory drugs? Comparing acetylated salicylates, nonacetylated salicylates, and nonacetylated nonsteroidal antiinflammatory drugs. Arthritis Rheum 1994; 37: 1–9

    Article  PubMed  CAS  Google Scholar 

  129. Rowbotham MC. Topical analgesic agents. In: Fields HL, Liebeskind JC, editors. Pharmacological approaches to the treatment of chronic pain: new concepts and critical issues. Seattle (WA): IASP Press, 1994: 211–27

    Google Scholar 

  130. Grahame R. Transdermal non-steroidal anti-inflammatory agents. Br J Clin Pract 1995 Jan–Feb; 49(1): 33–5

    PubMed  CAS  Google Scholar 

  131. Vaile JH, Davis P. Topical NSAIDs for musculoskeletal conditions: a review of the literature. Drugs 1998; 56: 783–99

    Article  PubMed  CAS  Google Scholar 

  132. Grace D, Rogers J, Skeith K, et al. Topical diclofenac versus placebo: a double blind, randomized clinical trial in patients with osteoarthritis of the knee. J Rheumatol 1999; 26(12): 2659–63

    PubMed  CAS  Google Scholar 

  133. Airaksinen L, Venalainen J, Pietilainen T, et al. Ketoprofen 2.5% gel versus placebo gel in the treatment of acute soft tissue injuries. J Clin Pharm Ther Toxicol 1993; 31: 561–3

    CAS  Google Scholar 

  134. Hawkey CJ. COX-2 Inhibitors. Lancet 1999; 353: 307–14

    Article  PubMed  CAS  Google Scholar 

  135. Chou CT, Tsai YY. A double-blind, randomized, controlled parallel group study evaluating the efficacy and safety of acemetacin for the management of osteoarthritis. Int J Clin Pharmacol Res 2002; 22(1): 1–6

    PubMed  CAS  Google Scholar 

  136. Willburger RE, Wittenberg RH, Schmidt K, et al. Antiinflammatory effect of tepoxalin. Acta Orthop Scand 1998; 69(3): 295–300

    Article  PubMed  CAS  Google Scholar 

  137. Van Hecken A, Schwartz JI, Depré M, et al. Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen and naproxen on COX-2 versus COX-1 in healthy volunteers. J Clin Pharmacol 2000; 40: 1109–20

    PubMed  Google Scholar 

  138. Celebrex® [prescribing information]. Karlsruhe [in German]: Pfizer, 2002

  139. Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. JAMA 2000 Sep; 284(10): 1247–55

    Article  PubMed  CAS  Google Scholar 

  140. Epstein M. Cardiovascular and renal effects of COX-2 specific inhibitors: recent insights and evolving clinical implications. Am J Ther 2001 Mar–Apr; 8(2): 81–3

    Article  PubMed  CAS  Google Scholar 

  141. Arzneimittelkommission der deutschen Ärzteschaft: Zur Sicherheit von COX-2-Inhibitoren Deutsches Ärzteblatt 99, Ausgabe 22 vom 31.05.2002, Scite A-1535/B-1308/C-1223

  142. Deeks JJ, Smith LA, Bradley MD. Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and reheumatoid arthritis: systematic review of randomised controlled trials. BMJ 2002 Sep; 325: 619–23

    Article  PubMed  CAS  Google Scholar 

  143. Depré M, Ehrich E, Van Hecken A, et al. Pharmacokinetics, COX-2 specifity, and tolerabilityof supratherapeutic doses of rofecoxib in humans. Eur J Clin Pharmacol 2000; 56: 167–74

    Article  PubMed  Google Scholar 

  144. Truitt KE, Sperling RS, Ettinger WH, et al. A multicenter, randomized, controlled trial to evaluate the safety profile, tolerability, and efficacy of rofecoxib in advanced elderly patients with osteoarthritis. Aging Clin Exp Res 2001; 13: 112–21

    CAS  Google Scholar 

  145. Cannon GW, Caldwell JR, Holt P, et al. Rofecoxib, a specific inhibitor of cyclooxygenase 2with clinical efficacy comparable with that of diclofenac sodium. Arthritis Rheum 2000 May; 43(5): 978–87

    Article  PubMed  CAS  Google Scholar 

  146. Mamdani M, Rochon PA, Juurlink DN, et al. Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs. BMJ 2002 Sep; 325: 624–7

    Article  PubMed  CAS  Google Scholar 

  147. FitzGerald GA, Cheng Y, Austin S. COX-2 inhibitors and the cardiovascular system. Clin Exp Rheumatol 2001; 19Suppl. 25: S31–6

    PubMed  CAS  Google Scholar 

  148. Ray WA, Stein CM, Daugherty JR, et al. COX-2 selective non-steroidal anti-inflammatory drugs and risk of serious coronary heart disease. Lancet 2002 Oct; 360: 1071–3

    Article  PubMed  CAS  Google Scholar 

  149. White WB, Kent J, Taylor A, et al. Effects of celecoxib on ambulatory blood pressure in hypertensive patients on ACE inhibitors. Hypertension 2002; 39: 929–34

    Article  PubMed  CAS  Google Scholar 

  150. Brater CD, Harris C, Redfern JS. Renal effects of COX-2-selective inhibitors. Am J Nephrol 2001; 21: 1–15

    Article  PubMed  CAS  Google Scholar 

  151. Zhao SZ, Reynolds MW, Lefkowith JB, et al. A comparison of renal-related adverse drug reactions between rofecoxib and celecoxib based on the World Health Organisation/Uppsala Monitoring Centre safety database. Clin Ther 2001; 23: 1478–91

    Article  PubMed  CAS  Google Scholar 

  152. Catella-Lawson F, McAdam B, Morrison BW. Effects of specific inhibition of cyclooxygenase-2 on sodium balance, hemodynamics and vasoactive eicosanoids. J Pharmacol Exp Ther 1999; 289: 735–41

    PubMed  CAS  Google Scholar 

  153. Swan SK, Rudy DW, Lasseter KC, et al. Effect of cyclooxygenase-2 inhibition on renal function in elderly persons receiving a low-salt diet. Ann Intern Med 2000; 133: 1–9

    PubMed  CAS  Google Scholar 

  154. Cheer SM, Goa KL. Parecoxib (parecoxib sodium). Drugs 2001; 61(8): 1133–41

    Article  PubMed  CAS  Google Scholar 

  155. Daniels SE, Grossmann EH, Kuss ME, et al. A double-blind, randomised comparison of intramusculary and intravenuosly administered parecoxib sodium versus ketorolac and placebo in a post-oral surgery pain model. Clin Ther 2001; 23(7): 1018–31

    Article  PubMed  CAS  Google Scholar 

  156. Grimm V, Rakoski J, Ring J. Urticaria and angioedema induced by COX-2 inhibitors. J Allergy Clin Immunol 2002; 109(2): 370–4

    Article  PubMed  Google Scholar 

  157. Breidung R. Schmerztherapie. Stuttgart: Aesopus-Verlag, 2002

    Google Scholar 

  158. Bradly JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen and acetaminophen in the treatment of patients with osteoarthritis in the knee. N Engl J Med 1991; 325: 87–91

    Article  Google Scholar 

  159. Courtney P, Doherty M. Key questions concerning paracetamol and NSAIDs for osteoarthritis. Ann Rheum Dis 2002; 61(9): 767–73

    Article  PubMed  CAS  Google Scholar 

  160. Rumore MM, Blaiklock RG. Influence of age-dependent pharmacokinetics and metabolism on acetaminophen hepatotoxicity. J Pharm Sci 1992; 81: 203–7

    Article  PubMed  CAS  Google Scholar 

  161. Gloth FM. Pain management in older adults: prevention and treatment. J Am Geriatr Soc 2001; 49: 188–99

    Article  PubMed  Google Scholar 

  162. Wynne HA, Cope LH, Herd B, et al. The association of age and frailty with paracetamol conjugation in man. Age Ageing 1990; 19(6): 419–24

    Article  PubMed  CAS  Google Scholar 

  163. Whitcomb DC, Block GD. Association of acetaminophen hepatotoxicity with fasting and alcohol use. JAMA 1994; 272: 1845–50

    Article  PubMed  CAS  Google Scholar 

  164. Dart RC, Kuffner EK, Rumack BH. Treatment of pain or fever with paracetamol (acetaminophen) in the alcoholic patient: a systematic review. Am J Ther 2000; 7(2): 123–34

    Article  PubMed  CAS  Google Scholar 

  165. Moynihan R. FDA fails to reduce accessibility of paracetamol despite 450 deaths a year. BMJ 2002; 325(7366): 678

    Article  PubMed  Google Scholar 

  166. Van den Bemt PMLA, Geven LM, Kuitert NA. The potential interaction between oral anticoagulants and acetaminophen in everyday practice. Pharm World Sci 2002; 24(5): 201–4

    Article  PubMed  Google Scholar 

  167. De Craen AJM, Di Giulio G, Lampe-Schoenmaeckers AJEM, et al. Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review. BMJ 1996; 313: 325–9

    Article  Google Scholar 

  168. Kjaersgaard-Andersen P, Nafei A, Skov O. Codeine plus paracetamol in longer-term treatment of chronic pain due to osteoarthritis of the hip: a randomised, double-blind, multi-centre study. Pain 1990; 43(3): 309–18

    Article  PubMed  CAS  Google Scholar 

  169. Pincus T, Swearingen C, Cummins P, et al. Preference for nonsteroidal antiinflammatory drugs versus acetaminophen and concomittant use of both types of drugs in patients with osteoarthritis. J Rheumatol 2000; 27(4): 1020–7

    PubMed  CAS  Google Scholar 

  170. Council for International Organizations of Medical Sciences. Benefit-risk balance for marketed drugs: evaluating safety signals. Geneva: CIOMS Working Group IV, 1998

    Google Scholar 

  171. Hedenmalm K, Spigset O. Agranulocytosis and other blood dyscrasias associated with dipyrone (metamizole). Eur J Clin Pharmacol 2002 Jul; 58(4): 265–74

    Article  PubMed  CAS  Google Scholar 

  172. International Agranulocytosis and Aplastic Anemia Study. Risks of agranulocytosis and aplastic anemia: a first report of their relation to drug use with special reference to analgesics. JAMA 1986; 256: 1749–57

    Article  Google Scholar 

  173. Martinez Martin P, Raffaelli Jr E, Titus F, et al. Efficacy and safety of metamizol vs acetylsalicylic acid in patients with moderate episodic tension-type headache: a randomized, double-blind, placebo- and active-controlled, multicentre study. Cephalgia 2001; 21(5): 604–10

    Article  CAS  Google Scholar 

  174. Zylber-Katz E, Granit L, Stessmann J, et al. Effect on age on the pharmacokinetics of dipyrone. Eur J Clin Pharmacol 1989; 36: 513–6

    Article  PubMed  CAS  Google Scholar 

  175. Novalgin® [prescribing information]. Frankfurt/Main: Avenus Pharma, 2000

  176. Radbruch L, Grond S, Lehmann KA. A risk-benefit assessment of tramadol in the management of pain. Drug Saf 1996; 15(1): 8–29

    Article  PubMed  CAS  Google Scholar 

  177. Mullican WS, Lacy JR. Tramadol/acetaminophen combination tablets and codein/acetaminophen combination capsules for the management of chronic pain: a comparative trial. Clin Ther 2001; 23: 1429–45

    Article  PubMed  CAS  Google Scholar 

  178. Raffa RB. Pharmacology of oral combination analgesics; rational therapy for pain. J Clin Pharmacol Ther 2001; 26: 257–64

    Article  CAS  Google Scholar 

  179. Cicero TJ, Adams EH, Geller A, et al. A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend 1999; 57: 7–22

    Article  PubMed  CAS  Google Scholar 

  180. Schnitzer TJ, Gray WI, Paster RZ, et al. Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol 2000; 27: 772–8

    PubMed  CAS  Google Scholar 

  181. Fleischmann RM, Caldwell JR, Roth SH, et al. Tramadol for the treatment of joint pain associated with osteoarthritis: a randomized, double-blind, placebo-controlled trial. Curr Ther Res Clin Exp 2001; 62: 113–28

    Article  CAS  Google Scholar 

  182. Harati Y, Gooch C, Swenson M, et al. Maintenance of long-term effectiveness of tramadol in treatment of the pain of diabetic neuropathy. J Diabetes Complications 2000; 14: 65–70

    Article  PubMed  CAS  Google Scholar 

  183. Moulin D. Tramadol for the treatment of the pain in diabetic neuropathy [letter]. Neurology 1999; 52: 1301

    Article  PubMed  CAS  Google Scholar 

  184. Tramai® [prescribing information]. Aachen: Grünenthal GmbH, 2003

  185. Caldwell JR, Hale ME, Boyd RE, et al. Treatment of osteoarthritis with controlled release oxycodone or fixed combination oxycodone plus acetaminophen added to nonsteroidal antiinflammatory drugs: a double-blind, randomized, multicenter, placebo controlled trial. J Rheumatol 1999; 26: 862–9

    PubMed  CAS  Google Scholar 

  186. Parris W, Johnson B, Croghan M, et al. The use of controlled-release oxycodone for the treatment of chronic cancer pain: a randomized, double-blind study. J Pain Symptom Manage 1998; 16: 205–11

    Article  PubMed  CAS  Google Scholar 

  187. Heiskanen T, Kalso E. Controlled-release oxycodone and morphine in cancer related pain. Pain 1997; 73: 37–45

    Article  PubMed  CAS  Google Scholar 

  188. Ytterberg S, Mahowald M, Woods S. Codeine and oxycodone use in patients with chronic rheumatic disease pain. Arthritis Rheum 1998; 41: 1603–11

    Article  PubMed  CAS  Google Scholar 

  189. Peloso P, Bellamy N, Bensen W, et al. Double blind randomized placebo control trial of controlled release codeine in the treatment of osteoarthritis of the hip or knee. J Rheumatol 2000; 27: 764–71

    PubMed  CAS  Google Scholar 

  190. Brennscheidt U, Sciler KU, Thomann P. Pharmacokinetics of nortilidine and naloxone after administration of tilidine/naloxone solution or tilidine/naloxone sustained release tablets. Arzneimittel Forschung 2000; 50: 1015–22

    PubMed  CAS  Google Scholar 

  191. Hajda JP, Jahnchen E, Oie S, et al. Sequential first-pass metabolism of nortilidine: the active metabolite of the synthetic opioid drug tilidine. J Clin Pharmacol 2002; 42: 1257–61

    Article  PubMed  CAS  Google Scholar 

  192. Wehrmann T, Rausch D, Sciler KU, et al. Tilidine does not affect human sphincter of Oddi motility: a randomized, controlled study. Aliment Pharmacol Ther 1997; 11: 987–92

    Article  PubMed  CAS  Google Scholar 

  193. Regenthal R, Kruger M, Richter M, et al. Poisoning with tilidine and naloxone: toxicokinetic and clinical observations. Hum Exp Toxicol 1998; 17: 593–7

    Article  PubMed  CAS  Google Scholar 

  194. Wörz R, Wörz E. Long-term treatment of chronic pain with tilidine-naloxone: an analysis of 50 patients with chronic pain conditions of non-malignant origin [in German]. Fortschr Med 1995; 113: 388–92

    PubMed  Google Scholar 

  195. Seiler KU, Jahnchen E, Trenk D, et al. Pharmacokinetics of tilidine in terminal renal failure. J Clin Pharmacol 2001; 41: 79–84

    Article  PubMed  CAS  Google Scholar 

  196. Bellville JW, Forrest WH, Miller E, et al. Influence of age on pain relief from analgesics: a study of postoperative patients. JAMA 1971; 271: 1835–941

    Article  Google Scholar 

  197. Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age: a simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 1987; 240: 159–65

    PubMed  CAS  Google Scholar 

  198. Kaiko RF. Age and morphine analgesia in cancer patients with postoperative pain. Clin Pharmacol Ther 1980; 28: 823–6

    Article  PubMed  CAS  Google Scholar 

  199. Weinberg DS, Inturrisu CE, Reidenberg B, et al. Sublingual absorption of selected opioid analgesics. Clin Pharmacol Ther 1988; 43: 335–42

    Article  Google Scholar 

  200. Tegeder I, Lotsch J, Geisslinger G. Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet 1999; 37: 17–40

    Article  PubMed  CAS  Google Scholar 

  201. Stanski DR, Greenblatt DJ, Lowenstein E. Kinetics of intravenous and intramuscular morphine. Clin Pharmacol Ther 1978; 24: 52–9

    PubMed  CAS  Google Scholar 

  202. Kaiko RF, Wallenstein SL, Rogers AG, et al. Narcotics in the elderly. Med Clin North Am 1982; 66: 1079–89

    PubMed  CAS  Google Scholar 

  203. Owen JA, Sitar DS, Berger L, et al. Age-related morphine kinetics. Clin Pharmacol Ther 1983; 34: 364–8

    Article  PubMed  CAS  Google Scholar 

  204. Baillie SP, Bateman DN, Coates PE, et al. Age and the pharmacokinetics of morphine. Age Ageing 1989; 18: 258–62

    Article  PubMed  CAS  Google Scholar 

  205. Chan K, Kendall MJ, Mitchard J, et al. The effect of aging on plasma pethidine concentration. Br J Clin Pharmacol 1975; 2: 297–302

    Article  PubMed  CAS  Google Scholar 

  206. Holmberg L, Odar-cederlof I, Boreus LO, et al. Comparative disposition of pethidine and norpethidine in the old and young patients. Eur J Clin Pharmacol 1982; 22: 175–9

    Article  PubMed  CAS  Google Scholar 

  207. Herman RJ, McAllister CD, Branch RA, et al. Effects of age on meperidine disposition. Clin Pharmacol Ther 1985; 37: 19–24

    Article  PubMed  CAS  Google Scholar 

  208. Odar-Cederlof I, Boreus LO, Bondesson U, et al. Comparison of renal excretion of meperidine and its metabolites in old and young patients. Eur J Clin Pharmacol 1985; 28: 171–5

    Article  PubMed  CAS  Google Scholar 

  209. Hanlon JT, O’Brien JG. The pharmacological management of the elderly patient with terminal cancer pain. J Ger Drug Ther 1989; 3: 5–30

    Google Scholar 

  210. Allan L, Hays H, Jensen NH, et al. Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. BMJ 2001; 322: 1154–8

    Article  PubMed  CAS  Google Scholar 

  211. Payne R, Mathias S, Pasta D, et al. Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine. J Clin Oncol 1998; 16: 1588–93

    PubMed  CAS  Google Scholar 

  212. Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life: The TTS-Fentanyl Comparative Trial Group. J Pain Symptom Manage 1997; 13: 254–61

    Article  PubMed  CAS  Google Scholar 

  213. Fine PG. Opioid analgesic drugs in older people. Clin Geriatr Med 2001; 17: 479–87

    Article  PubMed  CAS  Google Scholar 

  214. Holdsworth MT, Forman WB, Killilea TA, et al. Transdermal fentanyl disposition in elderly subjects. Gerontology 1994; 40: 32–7

    Article  PubMed  CAS  Google Scholar 

  215. Nugent M, Davis C, Brooks D, et al. Long-term observations of patients receiving transdermal fentanyl after a randomized trial. J Pain Symptom Manage 2001; 21: 385–91

    Article  PubMed  CAS  Google Scholar 

  216. Sloan PA, Moulin DE, Hays H. A clinical evaluation of transdermal therapeutic system fentanyl for the treatment of cancer pain. J Pain Symptom Manage 1998; 16: 102–11

    Article  PubMed  CAS  Google Scholar 

  217. Thompson JP, Bower S, Liddle AM, et al. Perioperative pharmacokinetics of transdermal fentanyl in elderly and young adult patients. Br J Anaesth 1998; 81: 152–4

    Article  PubMed  CAS  Google Scholar 

  218. Dellemijn PL, van Duijn H, Vanneste J. Prolonged treatment with transdermal fentanyl in neuropathic pain. J Pain Symptom Manage 1998; 16: 220–9

    Article  PubMed  CAS  Google Scholar 

  219. Lindena G, Arnau H, Liefhold J. Hydromorphone: review of pharmacological properties and therapeutic efficacy with special regard to a controlled release preparation [in German]. Schmerz 1998; 12: 195–204

    Article  PubMed  CAS  Google Scholar 

  220. Quigley C, Wiffen P. A systematic review of hydromorphone in acute and chronic pain. J Pain Symptom Manage 2003; 25: 169–78

    Article  PubMed  CAS  Google Scholar 

  221. Coursey CE. The psychomimetic side effects of pentazocine. Drug Intell Clin Pharm 1978; 12: 341–6

    Google Scholar 

  222. Li Wan Po A, Zhang WY. Systemic overview of co-proxamol to assess analgesic effects of addition of dextropropoxyphene to paracetamol. BMJ 1997; 315: 1565–71

    Article  PubMed  CAS  Google Scholar 

  223. Gray SL, Lai KV, Larson EB. Drug-induced cognition disorders in the elderly: incidence, prevention, and management. Drug Saf 1999; 21: 101–22

    Article  PubMed  CAS  Google Scholar 

  224. Weiner D, Hanlon JT, Studenski S. CNS drug-related fall liability in community-dwelling elderly. Gerontology 1998; 44: 217–21

    Article  PubMed  CAS  Google Scholar 

  225. Derby S, Portenoy RK. Assessment and management of opioid-induced constipation. In: Portenoy RK, Bruera E, editors. Topics in palliative care. New York: Oxford University Press, 1997: 95–112

    Google Scholar 

  226. Walsh TD. Prevention of opioid side effects. J Pain Symptom Manage 1999; 5: 363–7

    Google Scholar 

  227. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. cardiac and analgesic drugs. J Am Geriatr Soc 1999; 47: 40–50

    PubMed  CAS  Google Scholar 

  228. Egbert AM. Postoperative pain management in the frail elderly. Clin Geriatr Med 1996; 12: 583–99

    PubMed  CAS  Google Scholar 

  229. McQuay HJ, Carroll D, Glynn CJ. Low dose amitriptyline in the treatment of chronic pain. Anaesthesia 1992; 47: 646–52

    Article  PubMed  CAS  Google Scholar 

  230. Leo RJ, Singh A. Pain management in the elderly: use of psychopharmacologic agents. Ann Long-Term Care 2002; 10(2): 37–45

    Google Scholar 

  231. Bryson HM, Wilde MI. Amitriptyline: a review of its pharmacologic properties and therapeutic use in chronic pain states. Drugs Aging 1996; 8(6): 459–76

    Article  PubMed  CAS  Google Scholar 

  232. Lindsay PG, Olsen RB. Maprotiline in pain-depression. J Clin Psychiatry 1985 Jun; 46(6): 226–8

    PubMed  CAS  Google Scholar 

  233. Ansari A. The efficacy of newer antidepressants in the treatment of chronic pain: a review of the current literature. Harv Rev Psychiatry 2000; 7: 257–77

    PubMed  CAS  Google Scholar 

  234. Loldrup D, Langemark M, Hansen HJ, etal. Clomipramine and mianserin in chronic idiopathic pain syndrome. Psychopharmacology 1989; 99(1): 1–7

    Article  PubMed  CAS  Google Scholar 

  235. Yosselson-Superstine S, Lipman AG, Sanders SH. Adjunctive antianxiety agents in the management of chronic pain. Isr J Med Sci 1985; 21: 113–7

    PubMed  CAS  Google Scholar 

  236. Baron R, Wasner G, Lindner V. Optimal treatment of phantom limb pain in the elderly. Drugs Aging 1998 May; 12(5): 361–76

    Article  PubMed  CAS  Google Scholar 

  237. Jung AC, Staiger T, Sullivan M. The efficacy of selective serotonin reuptake inhibitors for the management of chronic pain. J Gen Intern Med 1997; 12(6): 384–9

    Article  PubMed  CAS  Google Scholar 

  238. Sindrup SH, Bjerre U, Dejgaard A, et al. The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. Clin Pharmacol Ther 1992 Nov; 52(5): 547–52

    Article  PubMed  CAS  Google Scholar 

  239. Sindrup SH, Gram LF, Brosen K, et al. The selective serotonin reuptake inhibitor citalopram relieves the syptoms of diabetic neuropathy. Pain 1990 Aug; 42(2): 135–44

    Article  PubMed  CAS  Google Scholar 

  240. Sindrup SH, Bach FW, Madsen C, et al. Venlafaxine versus imipramine in painful polyneuropathy: a randomized controlled trial. Neurology 2003 Apr 22; 60(8): 1284–9

    Article  PubMed  CAS  Google Scholar 

  241. Chiu HF. Antidepressants in the elderly. Int J Clin Pract 1997; 51(6): 369–74

    PubMed  CAS  Google Scholar 

  242. McQuay H, Carroll D, Jadad AR, et al. Anticonvulsant drugs for management of pain: a systematic review. BMJ 1995 Oct 21; 311(7012): 1047–52

    Article  PubMed  CAS  Google Scholar 

  243. Rice ASC, Maton S. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001; 94: 215–24

    Article  PubMed  CAS  Google Scholar 

  244. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomised controlled trial. JAMA 1998; 280: 1831–6

    Article  PubMed  CAS  Google Scholar 

  245. Zeyfang A, Nikolaus T. Activities of daily living (ADL) are more impaired among geriatric diabetic patients compared to non diabetic subjects [abstract]. Diabetologia 2002, 45 S1 A 304

    Google Scholar 

  246. Khan O. Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology 1998; 51: 611–4

    Article  PubMed  CAS  Google Scholar 

  247. Happe S, Klösch G, Saletu B, et al. Treatment of restless legs syndrome (RLS) with gabapentin. Neurology 2001; 57: 1717–9

    Article  PubMed  CAS  Google Scholar 

  248. Bone M, Buggy D, Critchley R, et al. Gabapentin monotherapy in postamputation limb and stump pain: a randomized double-blind, placebo-controlled, cross-over study [abstract]. Eur J Anaesth 2001; 18: S2/A454

    Article  Google Scholar 

  249. Schachter SC, Sauter MK. Treatment of central pain with gabapentin: case reports. J Epilepsy 1996; 9: 223–6

    Google Scholar 

  250. Backonja M, Glanzmann RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled trials. Clin Ther 2003 Jan; 25(1): 81–104

    Article  PubMed  CAS  Google Scholar 

  251. Laughlin TM, Tram KV, Wilcox GL. Comparison of antiepileptic drugs tiagabine, lamotrigine, and gabapentin in mouse models of acute, prolonged and chronic nociception. J Pharmacol Exp Ther 2002 Sep; 302(3): 1168–75

    Article  PubMed  CAS  Google Scholar 

  252. Chong MS, Libretto SE. The rationale and use of topiramate for treating neuropathiy pain. Clin J Pain 2003 Jan–Feb; 19(1): 59–68

    Article  PubMed  CAS  Google Scholar 

  253. Szallasi A. Vanilloid receptor ligands: hopes and realities for the future. Drugs Aging 2001; 18(8): 561–73

    Article  PubMed  CAS  Google Scholar 

  254. Watson CP, Evans PJ, Watt VR. Post-herpetic neuralgia and topical capsaicin. Pain 1988; 33: 333–40

    Article  PubMed  CAS  Google Scholar 

  255. Peikert A, Henrich M, Ochs G. Topical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy, predictors of response and long-term course. J Neurol 1991; 238(8): 452–6

    Article  PubMed  CAS  Google Scholar 

  256. McQuay H, Moore A. An evidence based resource for pain relief: topical capsaicin. Oxford: Oxford University Press, 1998: 249–51

    Google Scholar 

  257. Watson CPN. Topical Capsaicin as an adjuvant analgesic. J Pain Symptom Manag 1994; 9: 425–33

    Article  CAS  Google Scholar 

  258. Zhang WX, Li Wan Po A. The effectiveness of topically applied capsaicin: a metaanalysis. Eur J Clin Pharmacol 1999; 46: 517–22

    Google Scholar 

  259. Kastrup J, Bach FW, Petersen P, et al. Lidocaine treatment of painful diabetic neuropathy and endogenous opioid peptides in plasma. Clin J Pain 1989; 5(3): 239–44

    Article  PubMed  CAS  Google Scholar 

  260. Dejgard A, Petersen P, Castrup J. Mexiletine for treatment of chronic painful diabetic neuropathy. Lancet 1988; I: 9–11

    Article  Google Scholar 

  261. Felsby S, Nielsen J, Arendt-Nielsen L, et al. NMDA receptor blockade in chronic neuropathic pain: a comparison of ketamine and magnesium chloride. Pain 1995; 64: 283–91

    Article  Google Scholar 

  262. Nikolajsen L, Gottrup H, Kristensen AGD, et al. Memantine (a N-Methyl-D-Aspartate Receptor Antagonist) in the treatment of neuropathic pain after amputation or surgery: a randomized, double-blinded, cross-over study. Anesth Analg 2000; 91: 960–6

    Article  PubMed  CAS  Google Scholar 

  263. Nikolajsen L, Hansen CL, Nielsen J, et al. The effect of ketamine on phantom pain: a central neuropathic disorder maintained by peripheral input. Pain 1996; 67(1): 69–77

    Article  PubMed  CAS  Google Scholar 

  264. Sang CN, Booher S, Gilron I, et al. Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: efficacy and dose-response trials. Anesthesiology 2002 May; 96(5): 1053–61

    Article  PubMed  CAS  Google Scholar 

  265. Amin P, Sturrock ND. A pilot study of the beneficial effects of amantadine in the treatment of painful diabetic peripheral neuropathy. Diabet Med 2003 Feb; 20(2): 114–8

    Article  PubMed  CAS  Google Scholar 

  266. Gennari C. Analgesic effect of calcitonin in osteoporosis. Bone 2002 May; 30(5 Suppl.): 67S–70S

    Article  PubMed  CAS  Google Scholar 

  267. Silverman SL, Azria M. The analgesic role of calcitonin following osteoporotic fracture. Osteoporos Int 2002 Nov; 13(11): 858–67

    Article  PubMed  CAS  Google Scholar 

  268. Maksymowych WP. Managing acute osteoporotic vertebral fractures with calcitonin. Can Fam Physician 1998; 44: 2160–6

    PubMed  CAS  Google Scholar 

  269. Jaeger H, Maier C. Calcitonin in phantom limb pain: a double-blind study. Pain 1992; 48: 21–7

    Article  PubMed  CAS  Google Scholar 

  270. Martinez MJ, Roque M, Alonso-Coello P, et al. Calcitonin for metastatic bone pain. Cochrane Database Syst Rev 2003; 3: CD003223

    PubMed  Google Scholar 

  271. Hortobagyi GN, Theriault RL, Lester P, et al. Pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. N Engl J Med 1996; 335: 1785–91

    Article  PubMed  CAS  Google Scholar 

  272. Berenson JR, Lichtenstein A, Porter A, et al. Efficacy of pamidronate in reducing skeletal events in patients with multiple myeloma. N Engl J Med 1996; 334: 488–93

    Article  PubMed  CAS  Google Scholar 

  273. Nevitt MC, Thompson DE, Black DM, et al. Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Arch Intern Med Jan 2000; 160(10): 77–85

    Article  CAS  Google Scholar 

  274. Freidman DM, Moore ME. The efficacy of intraarticular steroids in osteoarthritis: a double-blind study. J Rheumatol 1980; 7: 850–6

    Google Scholar 

  275. Altman RD, Hochberg MC, Moskowitz RW, et al. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 2000; 43: 1905–15

    Article  Google Scholar 

  276. Hollander JL. Intrasynovial corticosteroid therapy in arthritis. Md State Med J 1970; 19: 62–6

    PubMed  CAS  Google Scholar 

  277. Khojainova N, Santiago-Palma J, Kornick C, et al. Olanzapine in the management of cancer pain. J Pain Symptom Manage 2002; 23(4): 346–50

    Article  PubMed  CAS  Google Scholar 

  278. Rumore MM, Schlichting DA. Clinical efficacy of antihistaminics as analgesics. Pain 1986; 25: 7–22

    Article  PubMed  CAS  Google Scholar 

  279. Campbell FA, Tramèr MR, Carroll D, et al. Are cannabinoids an effective and safe treatment option for the management of pain? A qualitative systematic review. BMJ 2001; 323(7303): 13–6

    Article  PubMed  CAS  Google Scholar 

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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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  1. Bethesda Geriatric Clinic, University of Ulm, Zollernring 26, 89073, Ulm, Germany

    Thorsten Nikolaus & Andrej Zeyfang

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  1. Thorsten Nikolaus
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  2. Andrej Zeyfang
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Correspondence to Thorsten Nikolaus.

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Nikolaus, T., Zeyfang, A. Pharmacological Treatments for Persistent Non-Malignant Pain in Older Persons. Drugs Aging 21, 19–41 (2004). https://doi.org/10.2165/00002512-200421010-00003

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