Tratamiento del dolor en el anciano: opioides y adyuvantes

Abstract

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.

Management of postoperative pain in the elderly. Literature review

“…This alters the distribution volume of multiple drugs (increasing the half-life time of lipophilic drugs such as diazepam and lidocaine, and reducing the half-life of water-soluble drugs such as acetaminophen and morphine). Additionally, age-related albumin reduction may increase the free fractions of large number of drugs and upregulate α-1acid glycoprotein expression, resulting in a higher possibility of adverse drug-related reactions (17).…”

“…With aging, hepatic flow and clearance, and the number of functional hepatocytes diminish, resulting in less effective oxidation and cytochrome-related processes. For that reason, older individuals may need more time to metabolize the same dose of a drug (17).…”

“…• Hydromorphone: It is recommended to initiate with an intravenous dose of 0.2-1 mg every 4-6 hours, given that age does not affect the pharmacokinetics of the drug. However, in moderate/severe liver or kidney failure, the dose should be reduced by 25-50% (creatinine [Cr] < 30 mL/min and Child Pugh B) (19,29). It is important to remember that the drug is readily cleared in patients on hemodialysis, with a 60% reduction over the predialysis dose, thus requiring dose adjustments (29).…”

“…However, in moderate/severe liver or kidney failure, the dose should be reduced by 25-50% (creatinine [Cr] < 30 mL/min and Child Pugh B) (19,29). It is important to remember that the drug is readily cleared in patients on hemodialysis, with a 60% reduction over the predialysis dose, thus requiring dose adjustments (29).…”

Dolor abdominal agudo en el adulto mayor: evaluación clínica, diagnóstico y tratamiento

“…Los adultos mayores tienen un riesgo del 10 al 25% mayor que los adultos jóvenes de presentar efectos adversos asociados a medicamentos 38 . Dado que la disminución en el funcionamiento renal y hepático, los cambios en la composición corporal, las enfermedades crónicas y la polifarmacia aumentan el riesgo de desarrollar efectos farmacológicos adversos 30,39 , el uso de analgésicos en los adultos mayores deberá iniciarse con las dosis mínimas necesarias para obtener una analgesia eficaz sin incrementar el riesgo de efectos secundarios indeseados (sedación excesiva, depresión respiratoria, lesión renal aguda y hemorragia gastrointestinal, entre otros) y, en caso de ser necesario, los incrementos en la dosificación deberán realizarse lentamente.…”