Age and the Pharmacokinetics of Morphine

Baillie, S. P.; Bateman, D. N.; Coates, P. E.; Woodhouse, K. W.

doi:10.1093/ageing/18.4.258

Cited by 91 publications

(45 citation statements)

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“…An age-related decrease in opioid self-administration has been well-documented (Burns et al, 1989;Giuffre et al, 1991;Macintyre and Jarvis, 1995;. This has been attributed to age-related increases in the analgesic efficacy of opioids (Kaiko, 1980;Mqore et al, 1990) which may be secondary to agerelated changes in morphine metabolism (Owen et al, 1983;Baillie et al, 1989;Laizure et al, 19931, Van Crugten et al, 1997). Unfortunately, the current study did not assess morphine pharmacology, making it impossible to determine the role of this factor in the differences observed.…”

Section: Discussionmentioning

confidence: 99%

Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients

Gagliese

Katz

2003

Pain

148

109

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As the population ages, research into the assessment of postoperative pain in older patients is urgently needed. The reliability and validity of most pain scales for the assessment of acute postoperative pain in the elderly remain to be demonstrated. The present study reports the analysis of age-related patterns on three pain scales (McGill Pain Questionnaire, MPQ; Present Pain Intensity, PPI; and Visual Analog Scale, VAS) completed by younger (n:95, mean age:56.4r-5.8 years) and older (n:105; mean age:66.8 +2.7 years) men following radical prostatectomy. All patients received intravenous morphine via patient-controlled analgesia (PCA) throughout the study. On the first 2 postoperative days (POD), patients completed the pain scales and PCA opioid intake was recorded. An interaction was found between amount of opioid self-administered and POD. In both groups, less opioid was administered on POD 2 than POD 1, but the decrease over time was greater in younger than older men. On both PODs, older men self-administered less opioid than younger men. Age differences in pain were dependent on the pain scale used. Older men had significantly lower scores than younger men on the MPQ and PPI but there were no differences on the VAS. Several age differences in the psychometric properties of the scales were evident. On both PODs, the correlation between VAS and MPQ scores was significantly lower in the older than younger group. POD effect sizes did not differ between the scales or age groups suggesting that all three scales have comparable sensitivity within an age group. However, the different results between the scales for the effect of age suggests that the VAS is not sufficiently sensitive to detect age differences. Therefore, age differences in postoperative pain are better captured by verbal descriptions of pain qualities than non-verbal measures of intensity.

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Section: Discussionmentioning

confidence: 99%

Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients

Gagliese

Katz

2003

Pain

148

109

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“…It has been reported that the dose requirements for drugs, including morphine, decreased with increasing age [6][7][8]. Baillie et al [6] reported that oral doses of morphine produced higher plasma concentrations in elderly volunteers (mean age, 74 years) than in young volunteers (mean age, 27 years), because fi rst-pass metabolism and clearance in the elderly group had decreased.…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients

et al. 2009

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“…It is available in both immediate- and slow-release preparations. However, it has variable bioavailability, may need extra vigilance in the elderly and in renal dysfunction and has potential side effects in many patients [38,39,40]. …”

Section: Why Use Morphine?mentioning

confidence: 99%

Neuropathic Pain – The Case for Opioid Therapy

Allen

2008

Oncology

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For many patients, neuropathic pain (NeP) is arguably more difficult to control than nociceptive or ‘normal’ pain. We also now recognise the great burden that NeP has on the lives of patients – it is not only a matter of treating pain in isolation, but managing all of the issues that affect the patient’s quality of life. Until relatively recently we have had little understanding of the pathophysiology causing NeP and have relied on the secondary effects of non-analgesic drugs as the mainstays of treatment. Greater understanding of the pathophysiology of NeP has led to more appropriate therapy and an increased use of multiple drug therapy – ‘rational polypharmacy’. Traditional opinions concerning the treatment of NeP have been challenged and it is because of this that the use of opioids in NeP has been re-evaluated. Opioids will never replace tricyclic antidepressants and anti-epileptic drugs as first-line therapy for NeP. However, they are now fully established as effective and useful second- or third-line drugs. Many patients in the past have been potentially undertreated as a result of our inertia to use opioids. The case for opioid therapy in NeP has been firmly established.

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Age and the Pharmacokinetics of Morphine

Cited by 91 publications

References 0 publications

Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients

Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients

Postoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients

Neuropathic Pain – The Case for Opioid Therapy

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