Pain and Inflammation Management in Older Adults: A Brazilian Consensus of Potentially Inappropriate Medication and Their Alternative Therapies

Motter, Fabiane Raquel; Hilmer, Sarah N.; Paniz, Vera Maria Vieira

doi:10.3389/fphar.2019.01408

Cited by 15 publications

(25 citation statements)

References 53 publications

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“…The American Geriatric Society recommends paracetamol as a first-line treatment for persistent pain with a 50–75% dose reduction in patients with liver failure [ 105 ]. Using a modified Delphi technique (two-round), a Brazilian expert panel suggested paracetamol as a possible alternative medication for pain in the elderly [ 107 ].…”

Section: Clinical Guidelinesmentioning

confidence: 99%

Paracetamol: A Review of Guideline Recommendations

Freo

Ruocco

Valerio

et al. 2021

JCM

108

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Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.

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Section: Clinical Guidelinesmentioning

confidence: 99%

Paracetamol: A Review of Guideline Recommendations

Freo

Ruocco

Valerio

et al. 2021

JCM

108

View full text Add to dashboard Cite

show abstract

“…However, the information collected in this study reinforces the need to optimize criteria adapted to the internal medicine and implement strategies that support the physician's decision when prescribing a possible PIM but always leaving the possibility of judgment and medical decision. Adaptation of these tools to a consensus tool for specific condition was already done for the management of pain and inflammation in older adults (Motter et al, 2019).…”

Section: Blancomentioning

confidence: 99%

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

et al. 2021

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Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM.Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant.Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria.Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.

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“…Recently, some efforts to develop and adapt tools for the Brazilian context have been observed. [29][30][31] However, to date, there are no published studies exploring the knowledge, attitudes and practices of healthcare professionals toward deprescribing in Brazil.…”

Section: Open Accessmentioning

confidence: 99%

Healthcare professionals’ knowledge, attitudes and practices toward deprescribing: a protocol of cross-sectional study (Desmedica Study—Brazil)

2021

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BackgroundDeprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. It is an activity that should be a normal part of care/the prescribing cycle. Although now broadly recognised, there are still challenges in its effective implementation.ObjectivesTo develop and validate an instrument to measure Brazilian healthcare professionals’ knowledge, attitudes and practices towards deprescribing.MethodsThis study will include the following steps: (1) development of the preliminary instrument; (2) content validation; (3) pilot study; (4) evaluation of psychometric characteristics. After the elaboration of items of the instrument through the literature review, we will use a hybrid Delphi method to develop and establish the content validity of the instrument. Further, a pilot survey will be performed with 30 healthcare professionals. Finally, for the evaluation of psychometric characteristics, a cross-sectional study will be accomplished with a representative sample of different healthcare professionals from different Brazilian states using respondent-driven sampling. Exploratory factor analysis and confirmatory factor analysis will be performed. For assessing the model fit, we will use the ratio of χ2 and df (χ2/df), comparative fit index, the goodness of fit index and root mean square error of approximation. In addition, the reliability of the instrument will be estimated by test–retest reproducibility and Cronbach’s alpha coefficient (α).Ethics and disseminationThe Ethics Committee for Research at the University of Sorocaba (ethics approval number: 3.848.916) approved the study. Study findings will be circulated to healthcare professionals and scientists in the field through publication in peer-reviewed journals and conference presentations.

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Pain and Inflammation Management in Older Adults: A Brazilian Consensus of Potentially Inappropriate Medication and Their Alternative Therapies

Cited by 15 publications

References 53 publications

Paracetamol: A Review of Guideline Recommendations

Paracetamol: A Review of Guideline Recommendations

Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

Healthcare professionals’ knowledge, attitudes and practices toward deprescribing: a protocol of cross-sectional study (Desmedica Study—Brazil)

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