Abstract
Chronic pain occurs in 45–85% of the geriatric population and the need to treat chronic pain is growing substantially. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life, with decreased socialization, depression, sleep disturbances, cognitive impairment, disability and malnutrition. Considering these consequences, healthcare professionals should aim at improving the diagnosis and treatment of chronic pain in older persons. One of the most important limitations in achieving successful pain management is that older people are not aware that pain management options exist or medications for pain, such as opioids, have associated benefits and adverse effects. Importantly, opioids do not induce any organ failure and if adequately used at the right dosage may only present some predictable and preventable adverse effects. Treating and controlling chronic pain is essential in elderly patients in order to maintain a good quality of life and an active role in both the family and society. To date there are only a few randomized clinical trials testing opioid therapy in elderly patients, and the aim of the present review is to highlight the efficacy and tolerability of opioid use through a literature search strategy in elderly people with chronic non-cancer pain.
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References
Landi F, Russo A, Liperoti R, et al. Daily pain and functional decline among old-old adults living in the community: results from the ilSIRENTE Study. J Pain Symptom Manage 2009 Sept; 38(3): 350–7
Soldato M, Liperoti R, Landi F, et al. Non malignant daily pain and risk of disability among older adults in home care in Europe. Pain 2007 Jun; 129(3): 304–10
Onder G, Cesari M, Russo A, et al. Association between daily pain and physical function among old-old adults living in the community: results from the ilSIRENTE study. Pain 2006 Mar; 121(1–2): 53–9
Onder G, Landi F, Gambassi G, et al. Association between pain and depression among older adults in Europe: results from the Aged in Home Care (AdHOC) project: a cross-sectional study. J Clin Psychiatry 2005 Aug; 66(8): 982–8
Landi F, Onder G, Cesari M, et al. Pain and its relation to depressive symptoms in frail older people living in the community: an observational study. J Pain Symptom Manag 2005 Mar; 29(3): 255–62
Di Iorio A, Abate M, Guralnik JM, et al. From chronic low back pain to disability, a multifactorial mediated pathway: the InCHIANTI study. Spine (Phila Pa 1976) 2007 Dec 15; 32(26): E809–15
Trescot AM, Helm S, Hansen H, et al. Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician 2008 Mar; 11 (2 Suppl.): S5–62
American Academy of Pain Medicine and the American Pain Society. The use of opioids for treatment of chronic pain. A consensus statement from the American Academy of Pain Medicine and the American Pain Society. 1997. Available at http://www.painmed.org [Accessed 2009 Aug 3]
Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006 May; 10(4): 287–333
Landi F, Onder G, Cesari M, et al. Pain management in frail, community-living elderly patients. Arch Intern Med 2001 Dec 10–24; 161(22): 2721–4
Pergolizzi J, Boger RH, Budd K, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 2008 Jul–Aug; 8(4): 287–313
Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clin Geriatr Med 2001 Aug; 17(3): 433–56, v–vi
Auret K, Schug SA. Underutilisation of opioids in elderly patients with chronic pain: approaches to correcting the problem. Drugs Aging 2005; 22(8): 641–54
McCleane G. Pharmacological pain management in the elderly patient. Clin Interv Aging 2007; 2(4): 637–43
Nicholson B, Passik SD. Management of chronic noncancer pain in the primary care setting. South Med J 2007 Oct; 100(10): 1028–36
Gallagher RM, Welz-Bosna M, Gammaitoni A. Assessment of dosing frequency of sustained-release opioid preparations in patients with chronic nonmalignant pain. Pain Med 2007 Jan–Feb; 8(1): 71–4
Simon S. Opioids and treatment of chronic pain: understanding pain patterns and the role for rapid-onset opioids. Med Gen Med 2005; 7(4): 54–65
Kahan M, Srivastava A, Wilson L, et al. Opioids for managing chronic non-malignant pain: safe and effective prescribing. Can Fam Physician 2006 Sept; 52(9): 1091–6
Kuehn BM. New pain guideline for older patients: avoid NSAIDs, consider opioids. JAMA 2009 Jul 1; 302(1): 19–32
Likar R, Vadlau EM, Breschan C, et al. Comparable analgesic efficacy of transdermal buprenorphine in patients over and under 65 years of age. Clin J Pain 2008 Jul–Aug; 24(6): 536–43
Griessinger N, Sittl R, Likar R. Transdermal buprenorphine in clinical practice — a post-marketing surveillance study in 13,179 patients. Curr Med Res Opin 2005 Aug; 21(8): 1147–56
Rigler SK, Shireman TI, Kallenbach L. Predictors of long-acting opioid use and oral versus transdermal route among older Medicaid beneficiaries. Am J Geriatr Pharmacother 2007 Jun; 5(2): 91–9
Roth SH, Fleischmann RM, Burch FX, et al. Around-the-clock, controlled-release oxycodone therapy for osteoarthritis-related pain: placebo-controlled trial and long-term evaluation. Arch Intern Med 2000 Mar 27; 160(6): 853–60
Itoh K, Katsumi Y, Hirota S, et al. Effects of trigger point acupuncture on chronic low back pain in elderly patients — a sham-controlled randomised trial. Acupunct Med 2006 Mar; 24(1): 5–12
Itoh K, Katsumi Y, Hirota S, et al. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complement Ther Med 2007 Sep; 15(3): 172–9
Yang KH, Kim YH, Lee MS. Efficacy of Qi-therapy (external Qigong) for elderly people with chronic pain. Int J Neurosci 2005 Jul; 115(7): 949–63
Lee MS, Yang KH, Huh HJ, et al. Qi therapy as an intervention to reduce chronic pain and to enhance mood in elderly subjects: a pilot study. Am J Chin Med 2001; 29(2): 237–45
Haas M, Groupp E, Muench J, et al. Chronic disease self-management program for low back pain in the elderly. J Manipulative Physiol Ther 2005 May; 28(4): 228–37
Ersek M, Turner JA, McCurry SM, et al. Efficacy of a self-management group intervention for elderly persons with chronic pain. Clin J Pain 2003 May–Jun; 19(3): 156–67
Barkin RL, Barkin SJ, Barkin DS. Perception, assessment, treatment, and management of pain in the elderly. Clin Geriatr Med 2005 Aug; 21(3): 465–90
Nikolaus T, Zeyfang A. Pharmacological treatments for persistent non-malignant pain in older persons. Drugs Aging 2004; 21(1): 19–41
Cowan DT. Chronic non-cancer pain in older people: current evidence for prescribing. Br J Community Nurs 2002 Aug; 7(8): 420–5
Manchikanti L, Singh V, Datta S, et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician 2009 Jul–Aug; 12(4): E35–70
Sadowski CA, Carrie AG, Grymonpre RE, et al. Access and intensity of use of prescription analgesics among older Manitobans. Can J Clin Pharmacol 2009 Summer; 16(2): e322–30
Kress HG. Clinical update on the pharmacology, efficacy and safety of transdermal buprenorphine. Eur J Pain 2009 Mar; 13(3): 219–30
Rauck RL, Raj PP, Knarr DC, et al. Comparison of the efficacy of epidural morphine given by intermittent injection or continuous infusion for the management of postoperative pain. Reg Anesth 1994 Sep–Oct; 19(5): 316–24
Pautex S, Herrmann F, Le Lous P, et al. Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients. J Gerontol A Biol Sci Med Sci 2005 Apr; 60(4): 524–9
Gianni W, Madaio RA, Di Cioccio L, et al. Prevalence of pain in elderly hospitalized patients. Arch Gerontol Geriatr 2009. Epub 2009 Dec 21
Chau SW, Soo LY, Lu DV, et al. Clinical experience of pain treatment for postherpetic neuralgia in elderly patients. Acta Anaesthesiol Taiwan 2007 Jun; 45(2): 95–101
Attal N, Cruccu G, Haanpaa M, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006 Nov; 13(11): 1153–69
Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997 Nov; 73(2): 123–39
Revill SI, Robinson JO, Rosen M, et al. The reliability of a linear analogue for evaluating pain. Anaesthesia 1976 Nov; 31(9): 1191–8
Myles PS, Troedel S, Boquest M, et al. The pain visual analog scale: is it linear or nonlinear? Anesth Analg 1999 Dec; 89(6): 1517–20
Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs 1997 Apr; 20(2): 88–93
Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with the use of morphine and opiates. J Intern Med 2006 Jul; 260(1): 76–87
Corsonello A, Pedone C, Corica F, et al. Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus. J Gerontol A Biol Sci Med Sci 2005 Sep; 60(9): 1147–51
Corsonello A, Pedone C, Corica F, et al. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med 2005 Apr 11; 165(7): 790–5
Glare PA, Walsh TD. Clinical pharmacokinetics of morphine. Ther Drug Monit 1991 Jan; 13(1): 1–23
Kress HG, Kraft B. Opioid medication and driving ability. Eur J Pain 2005 Apr; 9(2): 141–4
Dahan A, Yassen A, Bijl H, et al. Comparison of the respiratory effects of intravenous buprenorphine and fentanyl in humans and rats. Br J Anaesth 2005 Jun; 94(6): 825–34
Regnard C, Pelham A. Severe respiratory depression and sedation with transdermal fentanyl: four case studies. Palliat Med 2003 Dec; 17(8): 714–6
Walsh SL, Preston KL, Stitzer ML, et al. Clinical pharmacology of buprenorphine ceiling effects at high doses. Clin Pharmacol Ther 1994 May; 55(5): 569–80
Franceschi C, Bonafe M, Valensin S, et al. Inflamm-aging. An evolutionary perspective on immunosenescence. Ann N Y Acad Sci 2000 Jun; 908: 244–54
van den Biggelaar AH, Huizinga TW, de Craen AJ, et al. Impaired innate immunity predicts frailty in old age. The Leiden 85-plus study. Exp Gerontol 2004 Sep; 39(9): 1407–14
Mellon RD, Bayer BM. Evidence for central opioid receptors in the immunomodulatory effects of morphine: review of potential mechanism(s) of action. J Neuroimmunol 1998 Mar 15; 83(1–2): 19–28
Mellon RD, Bayer BM. Role of central opioid receptor subtypes in morphine-induced alterations in peripheral lymphocyte activity. Brain Res 1998 Apr 6; 789(1): 56–67
Peterson PK, Molitor TW, Chao CC. Mechanisms of morphine-induced immunomodulation. Biochem Pharmacol 1993 Aug 3; 46(3): 343–8
Martucci C, Panerai AE, Sacerdote P. Chronic fentanyl or buprenorphine infusion in the mouse: similar analgesic profile but different effects on immune responses. Pain 2004 Jul; 110(1–2): 385–92
Beilin B, Shavit Y, Hart J, et al. Effects of anesthesia based on large versus small doses of fentanyl on natural killer cell cytotoxicity in the perioperative period. Anesth Analg 1996 Mar; 82(3): 492–7
Jacobs R, Karst M, Scheinichen D, et al. Effects of fentanyl on cellular immune functions in man. Int J Immunopharmacol 1999 Jul; 21(7): 445–54
O’Connell MB, Frye RF, Matzke GR, et al. Effect of conjugated equine estrogens on oxidative metabolism in middle-aged and elderly postmenopausal women. J Clin Pharmacol 2006 Nov; 46(11): 1299–307
Dorne JL, Walton K, Slob W, et al. Human variability in polymorphic CYP2D6 metabolism: is the kinetic default uncertainty factor adequate? Food Chem Toxicol 2002 Nov; 40(11): 1633–56
Parkinson A, Mudra DR, Johnson C, et al. The effects of gender, age, ethnicity, and liver cirrhosis on cytochrome P450 enzyme activity in human liver microsomes and inducibility in cultured human hepatocytes. Toxicol Appl Pharmacol 2004 Sep 15; 199(3): 193–209
Schmucker DL. Aging and the liver: an update. J Gerontol A Biol Sci Med Sci 1998 Sept; 53(5): B315–20
Shimada T, Yamazaki H, Mimura M, et al. Interindividual variations in human liver cytochrome P-450 enzymes involved in the oxidation of drugs, carcinogens and toxic chemicals: studies with liver microsomes of 30 Japanese and 30 Caucasians. J Pharmacol Exp Ther 1994 Jul; 270(1): 414–23
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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
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Gianni, W., Ceci, M., Bustacchini, S. et al. Opioids for the Treatment of Chronic Non-Cancer Pain in Older People. Drugs Aging 26 (Suppl 1), 63–73 (2009). https://doi.org/10.2165/11534670-000000000-00000
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DOI: https://doi.org/10.2165/11534670-000000000-00000