The use of opioids in the treatment of oncologic pain in the elderly

Abstract

BACKGROUND AND OBJECTIVES: The use of opioids in cancer is already widespread and proven by several well-controlled clinical trials. However, the elderly with cancer pain are undertreated due to the lack of knowledge in the management of these patients, the underestimation of pain, as well as the fear of complications arising in this age group. Therefore, the scientific community contributes to giving inputs to create possible clinical and health guidelines. The present study aimed to perform a systematic literature review of opioid treatments proposed for cancer-related pain in elderly patients. CONTENTS: The search on the literature included papers addressing cancer pain treatment with opioids among the elderly, published from 2008 to 2018, and available in Portuguese or English. Searches were conducted on Medical Literature, Analysis, and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) electronic databases using the keywords "cancer pain", "opioids", and "elderly" in both languages, combined with the Boolean operator "AND". To analyze the quality of the method, the adapted Critical Appraisal Skills Programme was used. Of a total of 411 studies found, 32 were included. About 75% of the selected articles were published in the last five years. CONCLUSION: The results showed that opioids remain the pillar to treat cancer-related pain in the elderly. They can be used for better management of pain, but with caution due to the possible adverse effects. In addition, pain management in the elderly requires a multifactorial analysis, including comorbidities, polypharmacy, and patient functionality. Therefore, an individualized approach in the elderly patient is required in order to enhance results, reduce side effects, and improve quality of life.

Historical aspects in pain management in palliative care in an oncological reference unit

“…Therefore, in view of this situation of need and availability of opioids, the importance of designing and implementing laws, regulations and guidelines that include the safe management of controlled drugs is highlighted, preventing unnecessary barriers of access for patients; in addition, it is relevant to support services that develop palliative care (4) . Despite the scientific evidence that supports the use of opioids in the control of cancer pain (19)(20) , and also the WHO recommendations to ensure adequate availability, studies have reported that 75% of the world population still need adequate access to these analgesics (21) .…”

Intervenções Farmacológicas E Não Farmacológicas No Manejo Da Dor Oncológica: Uma Revisão De Literatura

“…Em relação ao terceiro degrau, o manejo adequado se dá por meio de opioides fortes, cuja revisão sistemática de Silva, et al (2020) encontrou efeitos positivos da morfina na dor nociceptiva com resposta de 85%, sendo inclusive o opioide mais utilizado no estudo de Sampaio, et al(2019). O fentanil, disponível em adesivo, é indicado para pacientes em situação de broncoaspiração, como disfagia e/ou odinofagia (SILVA et al, 2020). A hidromorfona é o único opioide que apresenta liberação monofásica controlada e promove analgesia dose-dependente contínua durante as 24 horas de intervalo entre duas doses.…”