Pharmacological Management of Persistent Pain in Older Persons

Reisner, Lori

doi:10.1016/j.jpain.2011.01.001

Cited by 29 publications

(16 citation statements)

References 54 publications

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“…Los analgésicos coadyuvantes son fármacos que se desarrollaron para otra indicación, pero que han demostrado ser útiles en el tratamiento del dolor persistente y refractario, especialmente neuropático (Tabla II) (30).…”

Section: Analgésicos Adyuvantesunclassified

“…El manejo del dolor en el anciano precisa de un conocimiento específico de los fármacos, de sus características farmacocinéticas y farmacodinámicas y de la relaciones entre éstas y el tipo de paciente anciano, con características diferentes en el paciente frágil. Al objetivo de aliviar el dolor, se debe sumar el de evitar yatrogenia (Tabla III) (30). Gastrointestinal Renal Cardiovascular SNC…”

Section: Conclusionesunclassified

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Tratamiento del dolor en el anciano: opioides y adyuvantes

López

Hernández

Mola³

et al. 2016

Rev. Soc. Esp. Dolor.

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There is a small number of primary studies relating to opioid use in older people. In carefully selected and monitored patients, opioids may provide effective pain relief as part of comprehensive pain management strategy. Use of strong opioids in the management of chronic, severe cancer and non-cancer pain in older people has been reviewed. Studies have demonstrated short-term efficacy in persistent musculoskeletal pain and various neuropathic pains. However, longer-term efficacy and safety data are lacking. Some adjuvant drugs should be considered for older people with neuropathic. Although tricyclic antidepressants have good efficacy, anticholinergic side effects are often problematic for older people. Anti-epileptic drugs such as gabapentin or pregabalin, are effective for neuropathic pain and are probably better tolerated. Topical administration may have improved tolerability than other routes of administration and may be preferable for elderly.

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Section: Analgésicos Adyuvantesunclassified

Section: Conclusionesunclassified

Tratamiento del dolor en el anciano: opioides y adyuvantes

López

Hernández

Mola³

et al. 2016

Rev. Soc. Esp. Dolor.

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“…Common ADRs, primarily dizziness, somnolence, edema, and gait disturbances, were reported in 66% of patients, but the ADRs were mostly tolerable, and the rate of serious ADEs was similar to placebo [140]. Pregabalin and gabapentin do not affect major CYP enzymes, which makes them less likely to have drug‐drug interactions [141]. Gabapentin levels can be increased by naproxen or morphine, and its absorption can be impaired by aluminum‐magnesium antacids [141].…”

Section: Commonly Administered Potentially Problematic Medicationsmentioning

confidence: 99%

“…Pregabalin and gabapentin do not affect major CYP enzymes, which makes them less likely to have drug‐drug interactions [141]. Gabapentin levels can be increased by naproxen or morphine, and its absorption can be impaired by aluminum‐magnesium antacids [141]. Consensus recommendations have established renal dosing for gabapentin in patients with chronic renal insufficiency: a maximum daily dose of 1200 mg for creatinine clearance (CrCl) 30‐59 mL/min, 600 mg for CrCl 15‐29 mL/min, and 300 mg for CrCl <15 mL/min or for patients on hemodialysis [142] (Table 2).…”

Section: Commonly Administered Potentially Problematic Medicationsmentioning

confidence: 99%

Polypharmacy and the Role of Physical Medicine and Rehabilitation

Geller

Nopkhun

Dows-Martinez

et al. 2012

PM&R

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Polypharmacy and inappropriate prescribing practices lead to higher rates of mortality and morbidity, particularly in vulnerable populations, such as the elderly and those with complex medical conditions. Physical medicine and physiatrists face particular challenges given the array of symptoms treated across a spectrum of conditions. This clinical review focuses on polypharmacy and the associated issue of potentially inappropriate prescribing. The article begins with a review of polypharmacy along with relevant aspects of pharmacokinetics and pharmacodynamics in the elderly. The adverse effects and potential hazards of selected medications commonly initiated and managed by rehabilitation specialists are then discussed with specific attention to pain medications, neurostimulants, antipsychotics, antidepressants, antispasmodics, sleep medications, and antiepileptics. Of particular concern is the notion that an adverse effect of one medication can mimic an indication for another and lead to a prescribing cascade and further adverse medication events. Appropriate prescribing practices mandate an accurate, current medication list, yet errors and inaccuracies often plague such lists. The evidence to support explicit (medications to avoid) and implicit (how to evaluate) criteria is presented along with the role of physicians and patients in prescribing medications. A brief discussion of "medication debridement" or de-prescribing strategies follows. In the last section, we draw on the essence of physiatry as a team-based endeavor to discuss the potential benefits of collaboration. In working to optimize medication prescribing, efforts should be made to collaborate not only with pharmacists and other medical specialties but with members of inpatient rehabilitation teams as well.

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“…Pain is a common complaint among the aging population, particularly among the older residents of nursing homes (1)(2)(3); it is mostly due to the increasing prevalence of age-related disorders, such as arthritis, osteoporosis, and peripheral vascular diseases (4), which are mostly progressive. Usually the resultant pain is persisting due to the degenerative nature of these conditions.…”

Section: Introductionmentioning

confidence: 99%

Pain characteristics of older residents in Iranian nursing homes

Foroughan

Shahboulaghi

Jafari

et al. 2019

East Mediterr Health J

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Background: Pain is a common complaint among the aging population, particularly among the older residents of nursing homes. Aims: The main aim of the study was to examine the pain characteristics among older residents of nursing homes in Tehran, Islamic Republic of Iran. Methods: This was a cross-sectional study. The sample consisted of 394 older adults admitted to Tehran nursing homes. To gather the required data, Brief Pain Inventory and Abbreviated Mental Test score were used. Results: 51% of the female and 26% of the male participants suffered from pain. Lower extremity and lower part of back were the most frequently affected. Pain interfered with general activity (P < 0.001), mood (P = 0.016), walking (P < 0.001), normal work (P < 0.001), relations with others (P = 0.043), sleeping (P = 0.002) and enjoyment of life (P = 0.019) of the older residents and these effects were more prominent in female sex. Factors such as age, gender and schooling were of significant relationships with pain (P < 0.001) and its intensity (P <0.001). Conclusions: Chronic pain is common among older residents of nursing homes and deteriorates their quality of life. This study reconfirms the previously mentioned importance of using effective pain evaluation and pain management strategies in nursing homes.

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Pharmacological Management of Persistent Pain in Older Persons

Cited by 29 publications

References 54 publications

Tratamiento del dolor en el anciano: opioides y adyuvantes

Tratamiento del dolor en el anciano: opioides y adyuvantes

Polypharmacy and the Role of Physical Medicine and Rehabilitation

Pain characteristics of older residents in Iranian nursing homes

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