This systematic review summarizes existing evidence regarding the efficacy, safety, and abuse/misuse potential of opioids as treatment for chronic non-cancer pain (CP) in older adults. Multiple databases were searched to identify relevant studies published in English (1/1/80-7/1/09) with a mean study population age of 60 years or above. Forty-three articles were identified and retained for review. The weighted mean subject age was 64.1 years (mean age range: 60-73). Studies enrolled patients with osteoarthritis (70%), neuropathic pain (13%), or other pain-producing disorders (17%). The mean duration of treatment studies (n=40) was 4 weeks (range = 1.5–156 weeks), and only 5 (12%) lasted longer than 12 weeks. In meta-analyses, effect sizes were −0.557 (p<0.001) for pain reduction, −0.432 (p<0.001) for physical disability reduction, and 0.859 (p=0.309) for improved sleep. The effect size for the SF-36 physical component score was 0.191 (p = 0.171) and −0.220 (p =0.036) for the mental component score. Adults ages 65 and above (vs. less than 65) were equally likely to benefit from treatment. Common adverse events included constipation (median frequency of occurrence = 30%), nausea (28%), dizziness (22%), and prompted opioid discontinuation in 25% of cases. Abuse/misuse behaviors were negatively associated with advancing age. Among older adults with CP and no significant comorbidity, short-term use of opioids is associated with reductions in pain intensity, improved physical functioning, but decreased mental health functioning. The long-term safety, efficacy, and abuse potential of this treatment practice in diverse populations of older persons remain to be determined.

BackgroundThe use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.MethodsSix focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.ResultsMost participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.ConclusionsProviders perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.

The rates of thyroid cancer surgery complications are higher than predicted, and patients with older age, more comorbidities, and advanced disease are at greatest risk. Efforts to reduce complications are needed.

Bone events in patients with thyroid cancer are a poor prognostic indicator. Patients with follicular and medullary thyroid cancers are at especially high risk for skeletal complications.

Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.