Underutilisation of Opioids in Elderly Patients with Chronic Pain

Auret, Kirsten; Schug, Stephan A.

doi:10.2165/00002512-200522080-00002

Cited by 113 publications

(94 citation statements)

References 88 publications

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“…There is still a considerable inertia to use strong opioids in non-cancer pain [28]. A recent Europe-wide study of chronic non-cancer pain supports this view [29].…”

Section: Are Strong Opioids Used Enough In Nep?mentioning

confidence: 99%

Neuropathic Pain – The Case for Opioid Therapy

Allen

2008

Oncology

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For many patients, neuropathic pain (NeP) is arguably more difficult to control than nociceptive or ‘normal’ pain. We also now recognise the great burden that NeP has on the lives of patients – it is not only a matter of treating pain in isolation, but managing all of the issues that affect the patient’s quality of life. Until relatively recently we have had little understanding of the pathophysiology causing NeP and have relied on the secondary effects of non-analgesic drugs as the mainstays of treatment. Greater understanding of the pathophysiology of NeP has led to more appropriate therapy and an increased use of multiple drug therapy – ‘rational polypharmacy’. Traditional opinions concerning the treatment of NeP have been challenged and it is because of this that the use of opioids in NeP has been re-evaluated. Opioids will never replace tricyclic antidepressants and anti-epileptic drugs as first-line therapy for NeP. However, they are now fully established as effective and useful second- or third-line drugs. Many patients in the past have been potentially undertreated as a result of our inertia to use opioids. The case for opioid therapy in NeP has been firmly established.

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“…There is still a considerable inertia to use strong opioids in non-cancer pain [28]. A recent Europe-wide study of chronic non-cancer pain supports this view [29].…”

Section: Are Strong Opioids Used Enough In Nep?mentioning

confidence: 99%

Neuropathic Pain – The Case for Opioid Therapy

Allen

2008

Oncology

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“…There is evidence in the literature of undertreatment of pain in the elderly [48][49][50] and, specifically, underuse of opioids. 51 Potential barriers to opioid use inelderly populations may includepatient underreporting of pain, 11,52 patient apprehension (e.g., fear of addiction, worry over side effects, and fear that increasing dose indicates worsening condition), 48 and/or provider concerns related to age-related changes in physiology and altered pharmacology. 11 Furthermore, prescribers may be concerned about the potential for drugdisease and drug-drug interactions among patients with comorbid conditions.…”

Section: Discussionmentioning

confidence: 99%

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

Fisher

Urquhart

Johnston

2013

Journal of Pain and Symptom Management

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Context-Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.Objectives-To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.Methods-Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n = 657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.Results-In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR] = 3.18, 95% CI = 2.05-4.94), residence in a long-term care facility (OR = 2.19, 95% CI = 1.23-3.89), and a CRC cause of death (OR = 1.75, 95% CI = 1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR = 0.97, 95% CI = 0.95-0.99), male (OR = 0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR = 0.62, 95% CI = 0.41-0.93).Conclusion-PCPs may play an important role in enabling access to end-of-life care within the community.

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“…The risk of developing an addiction decreases with increased age and is lower in the older population. It ranges from 3% to 19%, and it is often lower in patients with no previous experience with opioids in their medical history [12].…”

Section: Pain In the Older Populationmentioning

confidence: 99%

The Impact of Combinations of Non-Steroidal Anti-Inflammatory Drugs and Anti-Hypertensive Agents on Blood Pressure

Kalafutova¹,

Jurašková

Vlček³

2014

Adv Clin Exp Med

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Nowadays NSAIDs are the most frequently used groups of drugs, especially because of their availability. Their consumption is high among older people, who are much more sensitive to the side effects, and who are often also taking other drugs which can interact with them. Moreover, the majority of the older population is suffering from hypertension. This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice. The severity of this drug interaction is classified as class C, with a recommendation to monitor therapy. However, even a minor long-term increase in blood pressure can significantly increase the risk of cardiovascular mortality, while mortality rates can possibly be reduced by sufficiently effective treatment of hypertension. Therefore, in clinical practice, this type of interaction should not be overlooked as a major cause of failure of hypertension treatment in older patients, as well in many cases in general. The present article focusses on the mechanism and the degree of influence on the blood pressure of particular types of antihypertensive agents used in combination with NSAID. Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all. Similarly, not every NSAID increases blood pressure. Many studies, some of which are analyzed in this article, present evidence of the degree of the influence NSAIDs have on blood pressure (Adv Clin Exp Med 2014, 23, 6, 993-1000). Hypertension is well known as one of the most common cardiovascular diseases. Approximately 690 m people around the world suffer from hypertension. It is one of the major risk factors causing arteriosclerosis, including atherogenic coronary artery disease in the form of ischemic heart disease [1]. Hypertension affects the majority of people over 65 years of age, occurring in up to 60% of this population [2]. In most cases, it accounts for subsequent organ damage or many other manifestations of cardiovascular diseases [2,3]. Adequate treatment of hypertension is important especially in older populations, as has been confirmed by the HYVET study [4]. Moreover, older populations often experience pain, both chronic and acute. The use of different analgesics therefore becomes a regular part of their lives. It should therefore be borne in mind that the treatment of hypertension may be significantly influenced by the concomitant use of other therapeutic classes.The authors of this article focused on clarifying the mechanisms of the influence on blood

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Underutilisation of Opioids in Elderly Patients with Chronic Pain

Cited by 113 publications

References 88 publications

Neuropathic Pain – The Case for Opioid Therapy

Neuropathic Pain – The Case for Opioid Therapy

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

The Impact of Combinations of Non-Steroidal Anti-Inflammatory Drugs and Anti-Hypertensive Agents on Blood Pressure

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