The Role of Opioid Analgesics in Geriatric Pain Management

Naples, Jennifer G.; Gellad, Walid F.; Hanlon, Joseph T.

doi:10.1016/j.cger.2016.06.006

Cited by 104 publications

(64 citation statements)

References 46 publications

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“…People aged ≥ 75 years escalated to doses ≥ 50 mg OMEs/day most rapidly and people aged 65–74 years escalated to doses ≥ 90 mg OMEs/day most rapidly. These findings are important, because age‐related pharmacokinetic and pharmacodynamics changes mean that older people are more susceptible to opioid‐related adverse events, such as drowsiness, falls and delirium . Research has shown that there is a 50% increase in brain sensitivity to opioids from ages 20 to 89 .…”

Section: Discussionmentioning

confidence: 99%

Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

et al. 2020

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Background and aims Strong and high-dose opioids are associated with opioid overdose and death. The objective of this study was to determine the rate and predictors of transitioning to high-dose or strong opioids among people initiating opioids. Design Retrospective cohort study. Setting Australia. Participants People initiating opioid analgesics from July 2013 to January 2018 were identified from a random 10% sample of Australia's Pharmaceutical Benefits Scheme eligible population. Measurements Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the predictors of escalating to ≥ 50 mg oral morphine equivalents (OMEs)/day (cohort 1); ≥ 90 mg OMEs/day (cohort 2) and transitioning from weak opioids to strong opioids (cohort 3) over 12 months of follow-up. Predictors included age, sex, number of comorbidities, history of depression, prior treatment for cancer and selected other medication use. Findings In total, 861 691 people initiated opioids at average doses < 50 mg OMEs/day (cohort 1), 874 401 at < 90 mg OMEs/day (cohort 2) and 603 884 initiated weak opioids (cohort 3). Overall, 1.4% of people escalated to doses ≥ 50 mg OMEs/day, 0.8% to doses ≥ 90 mg OMEs/day and 7.3% transitioned to strong opioids. The strongest predictors of transitioning included prior treatment for cancer [cohort 1: HR = 3.19, 95% CI = 3.00-3.40; cohort 2: HR = 4.19, 95% CI = 3.90-4.51; cohort 3: HR = 2.07, 95% CI = 1.95-2.18] and age ≥ 75 years (cohort 1: HR = 3.04, 95% CI = 2.73-3.38; cohort 2: HR = 2.51, 95% CI = 2.17-2.89; cohort 3: HR = 1.88, 95% CI = 1.80-1.96). Females transitioned to high doses and strong opioids less rapidly than males (cohort 1: HR = 0.79, 95% CI = 0.76-0.82; cohort 2: HR = 0.70, 95% CI = 0.66-0.73; cohort 3: HR = 0.95, 95% CI = 0.93-0.96). Conclusions In Australia, more than one in every 13 people initiating weak opioids transition to strong opioids. By extrapolation, more than 26 000 Australian adults initiating opioids escalate to high doses each year. People with cancer treatment history, older people and males transition to strong and high-dose opioids more rapidly than others.

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Section: Discussionmentioning

confidence: 99%

Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

et al. 2020

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“…Management of acute post‐amputation pain in patients with peripheral vascular disease is challenging due to the massive tissue damage involved, multiple underlying illnesses, long acting anticoagulative medication and the adverse effects of opioids increasing with age . Eighty percent of patients are over 65 years of age, and the post‐operative mortality is high .…”

Section: Introductionmentioning

confidence: 99%

Combination of perineural and wound infusion after above knee amputation: A randomized, controlled multicenter study

Plato

Peltoniemi

Kauhanen

et al. 2019

Acta Anaesthesiol Scand

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Background: Post-operative pain after an above-knee amputation is often severe, and in the elderly patients the adverse effects of post-operative opioids are evident.We hypothesized that continuous perineural local anesthetic infusion (CPI) combined to a wound infusion will reduce acute pain and opioid consumption compared to placebo after above knee amputation. Methods:Ninety-three patients going through an above knee amputation were recruited for this randomized, controlled trial. Two catheters were placed, one to the sciatic nerve sheath and one under the fasciae during the amputation. After two 10 mL boluses of ropivacaine 0.75% a post-operative infusion of ropivacaine 0.2% or placebo (NaCl 0.9%) at 2 mL/h was administered for 72 hours to both catheters. The primary outcome was average stump pain during the first 5 days. Results:The mean intensity of stump pain during the first five post-operative days was 1.4 (0.8) in the CPI group and 1.9 (0.9) in the placebo group on VRS, mean (SD), P = .006. The opioid consumption on first five post-operative days did not differ between the groups. Conclusion:A combination of continuous perineural and wound local anesthetic infusion seems to diminish the intensity of stump pain after above knee amputation.How to cite this article: von Plato H, Peltoniemi M, Kauhanen P, Löyttyniemi E, Hamunen K, Kontinen V; The FinAPain-1 study group. Combination of perineural and wound infusion after above knee amputation: A randomized, controlled multicenter study.

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“…Because both studies allowed a titration to effect as opposed to a forced titration procedure, the mean average doses were different across age groups, with generally lower doses in the older age group. The comparable incidence of TEAEs in view of the lower mean dosages in those aged !65 years is consistent with increased sensitivity to opioids with increasing age 22 or changes in opioid pharmacokinetics in older patients 23 .…”

Section: Discussionmentioning

confidence: 61%

Safety and tolerability of ALO-02 (oxycodone hydrochloride and sequestered naltrexone hydrochloride) extended-release capsules in older patients: a pooled analysis of two clinical trials

Wilson

Bass

Pixton

et al. 2019

Current Medical Research and Opinion

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Safety and tolerability of ALO-02 (oxycodone hydrochloride and sequestered naltrexone hydrochloride) extended-release capsules in older patients: a pooled analysis of two clinical trials, Current Medical Research and Opinion, 36:1, 91-99, ABSTRACT Objective: To assess the impact of age on the safety and tolerability of ALO-02, an abuse-deterrent opioid formulation consisting of oxycodone hydrochloride and sequestered naltrexone hydrochloride, in patients with chronic pain. Methods: Data from two clinical studies in patients with chronic low back pain or chronic non-cancer pain were analyzed. Patients aged !18 years who required continuous around-the-clock opioid analgesia for an extended period were grouped into !65 years and <65 years age groups. Treatmentemergent adverse events (TEAEs), use of concomitant medications, clinical laboratory measurements, and occurrences of opioid withdrawal using reported adverse events (AEs) and Clinical Opiate Withdrawal Scale (COWS) scores assessed safety. Data pooling was employed for the titration and maintenance phases of both studies. Results: Respectively 805 and 436 patients received !1 dose of ALO-02 in the titration and maintenance phases; 121 (15.0%) and 83 (14.6%) patients, respectively, were aged !65 years in the titration and maintenance phases. Average doses of ALO-02 were lower in the older patients in both phases. Incidences of TEAEs were comparable between age groups in both phases and generally lower in the maintenance phase. Concomitant medications were taken more often by patients aged !65 years. Incidences of potentially clinically significant laboratory results were low in both phases with no clinically important differences between age groups. There were few reports of opioid withdrawal events as assessed by reported AEs and COWS scores. One patient aged !65 years experienced an AE of opioid withdrawal. Conclusions: The safety and tolerability of ALO-02 is similar in those aged !65 years and those aged <65 years with chronic pain. ClinicalTrials.gov identifiers: NCT01571362, NCT01428583. ARTICLE HISTORY

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The Role of Opioid Analgesics in Geriatric Pain Management

Cited by 104 publications

References 46 publications

Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

Combination of perineural and wound infusion after above knee amputation: A randomized, controlled multicenter study

Safety and tolerability of ALO-02 (oxycodone hydrochloride and sequestered naltrexone hydrochloride) extended-release capsules in older patients: a pooled analysis of two clinical trials

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