The Comparative Safety of Analgesics in Older Adults With Arthritis

Solomon, Daniel H.

doi:10.1001/archinternmed.2010.391

Cited by 368 publications

(319 citation statements)

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“…While HIV-infected patients frequently experience pain and are in need of effective treatment, 13,17,46 data suggest there may be potential harm from opioids. For example, data indicate that compared to other analgesics, opioids are associated with increased cardiovascular events and fractures 19,21 both of which occur more commonly among HIV-infected patients. 26,47 Similarly, some evidence suggests that opioids may adversely impact the immune system.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15] The benefits of opioids for treating painful conditions, such as neuropathy and osteonecrosis, which may occur more commonly among HIV-infected patients, must be balanced against 16,17 the possibility of increased risk for harm. Opioids may impact immune function, 18 be associated with toxicities [19][20][21] and interact with antiretrovirals. 22 There are limited recent data examining factors associated with opioid prescribing to HIV-infected patients.…”

Section: Introductionmentioning

confidence: 99%

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Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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BACKGROUND: Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES: To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN: Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS: HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES: Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS: Among the HIV+ (n = 23,651) and uninfected (n=55,097) patients, 31 % of HIV+ and 28 % of uninfected (p<0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p=0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p<0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p<0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p< 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS:Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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“…3,4 Other harms, especially falls and fractures, may be more common and worrisome among older adults. 5 Falls are an important mechanism of serious trauma and the most common cause of injury-related emergency visits among older adults. 6,7 Fracture is a serious potential consequence of falling, which among older adults can lead to significant morbidity, loss of independence, or death, especially in the case of hip fracture.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Fracture is a serious potential consequence of falling, which among older adults can lead to significant morbidity, loss of independence, or death, especially in the case of hip fracture. 8,9 Most prior studies have found positive associations between the use of opioid analgesics and fractures in older adults, 5,[10][11][12] but evidence for an association between opioid use and falls has been inconsistent. 13,14 Importantly, chronic musculoskeletal pain is also associated with declines in physical function [14][15][16][17][18] and increased risk of falling.…”

Section: Introductionmentioning

confidence: 99%

Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain

et al. 2016

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BACKGROUND: Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups, insufficient evidence is available regarding opioid harms in this age group. OBJECTIVE: To examine longitudinal relationships between opioid use and falls, clinical fractures, and changes in physical performance. We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance. DESIGN: We analyzed data from the Osteoporotic Fractures in Men Study (MrOS), a large prospective longitudinal cohort study. Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 (SD 4.0) years. PARTICIPANTS: MrOS enrolled 5994 communitydwelling men ≥ 65 years of age. The present study included 2902 participants with back, hip, or knee pain most or all of the time at baseline. MAIN MEASURES: The exposure of interest was opioid use, defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic. Among patients, 309 (13.4 %) reported opioid use at one or more visits. Participants were queried every 4 months about falls and fractures. Physical performance scores were derived from tests of grip strength, chair stands, gait speed, and dynamic balance. KEY RESULTS: In the main analysis, the adjusted risk of falling did not differ significantly between opioid use and non-use groups (RR 1.10, 95 % CI 0.99, 1.24). Similarly, adjusted rates of incident clinical fracture did not differ between groups (HR 1.13, 95 % CI 0.94, 1.36). Physical performance was worse at baseline for the opioid use group, but annualized change in physical performance scores did not differ between groups (−0.022, 95 % CI −0.138, 0.093). CONCLUSIONS: Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls, fractures, and progressive impairment among older adults with persistent pain.

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“…8,34,[41][42][43][44] As a result, a recent clinical review recommends initiating long-term opioid therapy only when patients have moderate to severe pain leading to substantial impairment in daily living and when all other treatment modalities have failed. 45 This is not a recommendation founded on demonstrable evidence of benefits exceeding harms.…”

Section: Harms Of Therapymentioning

confidence: 99%

The prescription opioid epidemic: an overview for anesthesiologists

Alam

Juurlink

2015

Can J Anesth/J Can Anesth

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Purpose The objectives for preparing this article were to review the historical context and epidemiology surrounding the North American prescription opioid crisis, to summarize the evidence regarding the benefits and harms of long-term opioid therapy for non-cancer pain, and to outline ways in which anesthesiologists may help ameliorate the problem. Source We searched PubMed, Google Scholar, and EMBASE TM for relevant articles using various search terms, including pain, opioid epidemic, history of opioid use, perioperative care, and addiction. Related citations were further explored and searched depending on the specific subtopic of interest. Principal findings In the 1980s and early 1990s, opioids were infrequently used for the treatment of chronic pain. Thereafter, however, physicians were gradually inculcated with the message that long-term opioid therapy was a safe and effective treatment option for patients with chronic non-cancer pain. Pharmaceutical companies supported this growing movement and employed aggressive and sometimes misleading marketing strategies for new opioid formulations. As a result, the practice of prescribing opioids flourished in the late 1990s. The surge in prescribing opioids was accompanied by a marked increase in opioid-related morbidity and mortality. This change in practice transpired despite the absence of randomized trials showing clinically significant benefit from the long-term use of opioids. Subsequently, however, a large and growing body of evidence has emerged quantifying the harms associated with long-term opioid therapy. Anesthesiologists widely prescribe opioids for acute and chronic pain; yet, as a group, they may be largely unaware of the current state of this growing epidemic and what role they can play to rectify this problem.Conclusion Anesthesiologists are well positioned to take a leadership role in the management of postoperative discharge opioid therapy in an effort to curb the overutilization of opioids. Furthermore, anesthesiologists who regularly prescribe opioids for chronic pain patients should appreciate the limited evidence base for this practice and communicate the risks of opioid therapy to their patients.

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The Comparative Safety of Analgesics in Older Adults With Arthritis

Abstract: The comparative safety of analgesics varies depending on the safety event studied. Opioid use exhibits an increased relative risk of many safety events compared with nsNSAIDs.

Cited by 368 publications

References 28 publications

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain

The prescription opioid epidemic: an overview for anesthesiologists

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