Evolving Pharmacological Management of Persistent Pain in Older Persons

Hanlon, Joseph T.; Backonja, M.; Weiner, Debra K.; Argoff, Charles

doi:10.1111/j.1526-4637.2009.00698.x

Cited by 20 publications

(11 citation statements)

References 10 publications

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“…26 In addition, it is known that the use of anti-inflammatories and analgesics is more common among women because of a higher prevalence of arthritis, osteoarthritis and rheumatism. 27,36,37 An association between the use of antiinflammatories and analgesics and selfperception of health was noted in the present study, with the worse the self-perception of health, the greater the use of these drugs. Antiinflammatory and analgesic use is directly related to pain.…”

Section: Discussionmentioning

confidence: 63%

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

Ely

Engroff

Guiselli

et al. 2015

Rev. bras. geriatr. gerontol.

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The aim of this study was to analyze the prevalence of the use of anti-inflammatory and analgesic drugs among elderly persons from the Family Health Program in Porto Alegre, Rio Grande do Sul, and investigate associated factors such as sociodemographic and health data; continuous or as needed use of drug, drug used subject to medical prescription or self-medicated. Data collection occurred between March 2011 and December 2012. Community health workers applied a questionnaire relating to sociodemographic and health data and medication use. Non-steroidal antiinflammatory drugs, glucocorticoids, non-opioid analgesics and opioids were evaluated. A total of 758 elderly persons were included and anti-inflammatory and analgesic drugs were used by 28.8% of the population. Acetaminophen and ibuprofen were the most frequently used drugs. Regarding self-perception of health, the worse the perception of health, the greater was the use of therapy ( p<0.001). Liver disease and osteoarthritis/ arthritis/rheumatism were found to be associated with anti-inflammatory and analgesic use ( p<0.001). The prevalence of anti-inflammatory and analgesic use was considered moderate when compared to previous studies (28.8%). In addition, most of the elderly persons used the drugs when only needed, most probably due to feeling minor to moderate pain or because they had suffered the adverse effects of these medications in the past and so chose to use them sporadically.

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Section: Discussionmentioning

confidence: 63%

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

Ely

Engroff

Guiselli

et al. 2015

Rev. bras. geriatr. gerontol.

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“…This does not mean that physicians should “start low and stay low,” which contributes to potential undertreatment. 53 Table 1 also provides information about recommended starting doses and frequency of administration.…”

Section: Methodsmentioning

confidence: 99%

Management of Persistent Pain in the Older Patient

Makris

Abrams

Gurland

et al. 2014

JAMA

269

201

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Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

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“…In general, if an NSAID is required one should consider the use of nonacetylated salicylates as they rarely cause GI bleeding, and they do not interfere with platelet function, even in patients taking aspirin. 45 …”

Section: Data Synthesismentioning

confidence: 99%

“…6,45,46 Opioids inhibit pain pathways by binding to the mu opioid receptors in the central nervous system. 4 The selection of an opioid analgesic for older patients with chronic pain is influenced by factors such as pain intensity, age-related alterations in pharmacokinetics/pharmacodynamics, comorbid conditions and adverse drug events.…”

Section: Data Synthesismentioning

confidence: 99%

Adverse Effects of Analgesics Commonly Used by Older Adults With Osteoarthritis: Focus on Non-Opioid and Opioid Analgesics

O’Neil

Hanlon

Marcum

2012

The American Journal of Geriatric Pharmacotherapy

Self Cite

221

159

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Background Osteoarthritis (OA) is the most common cause of disability in older adults, and while analgesic use can be helpful its use can also result in adverse drug events. Objective To review the recent literature to describe potential adverse drug events (ADEs) associated with analgesics commonly used by older adults with OA. Methods To identify articles for this review, a systematic search of English-language literature (January 2001 – June 2012) was conducted using PubMed, MEDLINE, EBSCO, and the Cochrane Database of Systematic Reviews for publications related to the medical management of osteoarthritis. Searches used a combination of the following search terms: analgesics, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, pharmacokinetics, pharmacodynamics and adverse drug events. We also restricted the search to those papers concerning humans ≥65 years of age. A manual search of the reference lists from identified articles and the authors’ article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that examined analgesic use in older adults. Results There are limited data to suggest that non-frail elders are more likely than their younger counterparts to develop acetaminophen-induced hepatotoxicity. However, decreased hepatic Phase 2 metabolism in frail elders may result in an increased risk of hepatotoxicity. Regarding NSAIDs, it is now well-established that older adults are at higher risk for NSAID-induced gastrointestinal toxicity and renal insufficiency. For opioids, the data suggesting an increased risk of falls/fractures/delirium need to be tempered by the potential risk of inadequately treating severe chronic OA pain. Conclusions Acetaminophen is the mainstay frontline analgesic for OA pain in older adults. NSAIDs should be limited to short-term use only, and for moderate to severe OA pain, opioids may be preferable in those without substance abuse or dependence issues.

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Evolving Pharmacological Management of Persistent Pain in Older Persons

Cited by 20 publications

References 10 publications

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

Management of Persistent Pain in the Older Patient

Adverse Effects of Analgesics Commonly Used by Older Adults With Osteoarthritis: Focus on Non-Opioid and Opioid Analgesics

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