Pharmacotherapy of Pain in the Older Population

Pharmacotherapy of Pain in the Older Population: The Place of Opioids – Front Aging Neurosci. 2016 Jun – free full-text PMC article

Pain is a common symptom in older people.

It is possible that pain is underreported in older persons due to an incorrect belief that it is an inevitable part of aging.

This suggests that pain is NOT an inevitable part of aging, which is simply not true of human beings.

Opioid analgesics are potent medications, with confirmed efficacy for the treatment of moderate to severe pain.

Unlike all the headlines and “studies” lately, this scientific article points out the truth that opioids are very effective.  

These drugs are commonly used in older persons.

However, there is insufficient evidence regarding safety of opioids in older patients.

One of the reasons for this is the lack of randomized, controlled clinical trials. People of advanced age often have comorbidites and use other prescription drugs, as well as over-the-counter (OTC) compounds, thus making them more susceptible to the risk of interactions with opioids.

Significant pharmacokinetic and pharmacodynamic changes that occur with advancing age increase the risk of adverse effects of opioids.

There are also some discrepancies between guidelines, which recommend the use of lower doses of opioids in older patients, and the findings in the literature which suggest that pain is often undertreated in this age group.

It seems that there are significant variations in the tolerability of different opioid analgesics in older people.

This is true of everyone, not just older people.

Morphine, fentanyl, oxycodone, and buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for these patients.

This goes directly against the CDC guidelines, which say opioids should never be a preferred choice.

However, the safety and efficacy of other opioids in older patients, especially if comorbidities and polypharmacy are present, is still questionable.

This review addresses the most important aspects of the use of opioids in older persons, focusing on pharmacokinetics, pharmacodynamics, adverse effects, and interactions.  

Conclusions

The pharmacologically-guided approach to the treatment of moderate to severe pain in older persons requires a systematic understanding of the pharmacokinetics and pharmacodynamics of analgesics.

An understanding of the changes associated with aging is very important for clinical use of opioids.

The absence of randomized controlled trials in the older population emphasizes the importance of relying on clinical judgment.

This is exactly the opposite of developing standards, like guidelines, which do NOT take into account the variations in responsiveness to opioids.

While a number of opioids may be commonly used in older people, some representatives of this class have an unacceptable risk to frail older patients.

It is important to follow guidelines for use of opioids in older age.

With this sentence, the article reverses itself by denying the critical need for clinical judgment to balance the individual’s needs and responses to medication with reduced pain.

There is an almost identical PMC article from around the same time: Pain Management in the Elderly

Advertisements

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s