M Schuler1, N Grießinger2. 1. Klinik für Geriatrie und Palliativmedizin, Diakonissenkrankenhaus, Speyerer Str. 91-93, 68163, Mannheim, Deutschland. matthias.schuler@diakonissen.de. 2. Schmerzambulanz, Anästhesiologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
Abstract
BACKGROUND: Opioids are increasingly used in the elderly. Side effects differ compared to other analgesics. PURPOSE: In this review article, special aspects about using opioids for noncancer pain in older people and in geriatric patients are identified. CURRENT SITUATION: So far randomized controlled trials for the indication of and comparison between various opioids have been performed in middle-aged patients and not exclusively in geriatric patients or elderly (> 75 years). Furthermore, the evidence for multimorbid elderly patients with respect to side effects is also very poor. RECOMMENDATIONS: The indication for opioid therapy should be narrow. The patient and their caregivers must be provided patient information regarding opioid therapy. The principle "start low, go slow" is highly recommended. To reduce the risk of falls, longer acting opioids should be used and short acting opioids should be avoided. Everyday relevant negative effects on cognition are possible in opioid use and have to be observed. As recommended in the recently published German guideline for long-term use of opioids in noncancer pain a critical check after 3 months and in case of dosing over 120 mg morphine equivalents is advisable, especially for older patients. Liver and kidney function and drug interactions have to be taken into consideration like in every age group.
BACKGROUND: Opioids are increasingly used in the elderly. Side effects differ compared to other analgesics. PURPOSE: In this review article, special aspects about using opioids for noncancer pain in older people and in geriatric patients are identified. CURRENT SITUATION: So far randomized controlled trials for the indication of and comparison between various opioids have been performed in middle-aged patients and not exclusively in geriatric patients or elderly (> 75 years). Furthermore, the evidence for multimorbid elderly patients with respect to side effects is also very poor. RECOMMENDATIONS: The indication for opioid therapy should be narrow. The patient and their caregivers must be provided patient information regarding opioid therapy. The principle "start low, go slow" is highly recommended. To reduce the risk of falls, longer acting opioids should be used and short acting opioids should be avoided. Everyday relevant negative effects on cognition are possible in opioid use and have to be observed. As recommended in the recently published German guideline for long-term use of opioids in noncancer pain a critical check after 3 months and in case of dosing over 120 mg morphine equivalents is advisable, especially for older patients. Liver and kidney function and drug interactions have to be taken into consideration like in every age group.
Authors: T Frühwald; M Weissenberger-Leduc; C Jagsch; K Singler; S Gurlit; W Hofmann; B Böhmdorfer; B Iglseder Journal: Z Gerontol Geriatr Date: 2014-07 Impact factor: 1.281
Authors: Robert H Dworkin; Richard L Barbano; Stephen K Tyring; Robert F Betts; Michael P McDermott; Janet Pennella-Vaughan; Gary J Bennett; Erhan Berber; John W Gnann; Carrie Irvine; Cornelia Kamp; Karl Kieburtz; Mitchell B Max; Kenneth E Schmader Journal: Pain Date: 2009-02-04 Impact factor: 6.961
Authors: Fabio Guerriero; Anna Roberto; Maria Teresa Greco; Carmelo Sgarlata; Marco Rollone; Oscar Corli Journal: Drug Des Devel Ther Date: 2016-04-19 Impact factor: 4.162