Analgesic use in the older person

Pickering, Gisèle

doi:10.1097/spc.0b013e32835242d2

Cited by 19 publications

(13 citation statements)

References 34 publications

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“…Non-prescription drugs, especially paracetamol, should be taken into consideration in community-dwelling patients. A number of physiological changes that can affect drug metabolism are also associated with aging, especially diminution of renal function [2, 23, 37, 38]. Adverse events such as constipation, vomiting, or nausea should be anticipated in older patients, especially in those using opioids [19, 39].…”

Section: Algorithmmentioning

confidence: 99%

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An Algorithm for Neuropathic Pain Management in Older People

et al. 2016

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Neuropathic pain frequently affects older people, who generally also have several comorbidities. Elderly patients are often poly-medicated, which increases the risk of drug–drug interactions. These patients, especially those with cognitive problems, may also have restricted communication skills, making pain evaluation difficult and pain treatment challenging. Clinicians and other healthcare providers need a decisional algorithm to optimize the recognition and management of neuropathic pain. We present a decisional algorithm developed by a multidisciplinary group of experts, which focuses on pain assessment and therapeutic options for the management of neuropathic pain, particularly in the elderly. The algorithm involves four main steps: (1) detection, (2) evaluation, (3) treatment, and (4) re-evaluation. The detection of neuropathic pain is an essential step in ensuring successful management. The extent of the impact of the neuropathic pain is then assessed, generally with self-report scales, except in patients with communication difficulties who can be assessed using behavioral scales. The management of neuropathic pain frequently requires combination treatments, and recommended treatments should be prescribed with caution in these elderly patients, taking into consideration their comorbidities and potential drug–drug interactions and adverse events. This algorithm can be used in the management of neuropathic pain in the elderly to ensure timely and adequate treatment by a multidisciplinary team.

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Section: Algorithmmentioning

confidence: 99%

“…In older patients, the ‘start low’ and ‘go slow’ approach should be used, i.e., start treatment at the lowest dose and titrate up depending on efficacy and tolerability. Monotherapy, local treatments, and oral rather than intravenous routes should be preferred [37, 40]. …”

Section: Algorithmmentioning

confidence: 99%

An Algorithm for Neuropathic Pain Management in Older People

et al. 2016

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“…Polypharmacy is very common in older persons 17 18 24 and increases the risk of drug-related adverse effects and interactions. 25–28 HZ requires the prescription of additional drugs, consisting of analgesics and sedatives with a central mechanism of action and potential adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month longitudinal prospective observational ARIZONA cohort study

et al. 2016

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ObjectivesTo examine the burden of comorbidity, polypharmacy and herpes zoster (HZ), an infectious disease, and its main complication post-herpetic neuralgia (PHN) in young (50–70 years of age: 70−) and old (≥70 years of age: 70+) patients.DesignPost hoc analysis of the results of the 12-month longitudinal prospective multicentre observational ARIZONA cohort study.Settings and participantsThe study took place in primary care in France from 20 November 2006 to 12 September 2008. Overall, 644 general practitioners (GPs) collected data from 1358 patients aged 50 years or more with acute eruptive HZ.Outcome measuresPresence of HZ-related pain or PHN (pain persisting >3 months) was documented at day 0 and at months 3, 6, and 12. To investigate HZ and PHN burden, pain, quality of life (QoL) and mood were self-assessed using validated questionnaires (Zoster Brief Pain Inventory, 12-item Short-Form health survey and Hospital Anxiety and Depression Scale, respectively).ResultsAs compared with younger patients, older patients more frequently presented with comorbidities, more frequently took analgesics and had poorer response on all questionnaires, indicating greater burden, at inclusion. Analgesics were more frequently prescribed to relieve acute pain or PHN in 70+ than 70− patients. Despite higher levels of medication prescription, poorer pain relief and poorer response to all questionnaires were reported in 70+ than 70− patients.ConclusionsOccurrence of HZ and progression to PHN adds extra burden on top of pharmacological treatment and impaired quality of life, especially in older patients who already have health problems to cope with in everyday life.

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“…On the treatment side, positive emotional states (Lumley et al 2011 ) and cognitive interventions (hypnosis, meditation, distraction, cognitive training (Kesler et al 2013 )) have given interesting results and may reduce pain. Non-pharmacological approaches are indeed recommended in synergy with pharmacological treatment, but the fi rst line of treatment of chronic pain remains predominately pharmacological (Pickering 2012 ). In that context, analgesics used for chronic pain have a number of cognitive and emotional side effects, and the role played by analgesics on cognitive function and emotional status is diffi cult to dissociate from the impact of chronic pain itself, clinically but also fundamentally.…”

Section: Introductionmentioning

confidence: 98%

Pharmacological Pain Management: For Better or for Worse?

Pickering

Lussier

2015

Pain, Emotion and Cognition

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Although taking advantage of the synergistic effect of nonpharmacological and pharmacological approaches for the treatment of pain is always recommended, drugs remain the fi rst and sometimes the only line of available treatment. Analgesics as well as pain itself do have an impact on cognitive and emotional processes. The cognitive/affective central effect of analgesics prescribed for chronic pain treatment is well documented in the literature, but the causal relationship of pain to cognitive and emotional disorders remains to be explored. In order to provide satisfactory pain alleviation, analgesic treatment in frail patients and in patients with preexisting cognitive/affective impairment is particularly diffi cult. Considering the large array of adverse events of orally administered analgesics, topical analgesics may be an interesting option for pain treatment. Non-pharmacological therapies should always be included in a comprehensive pain management plan.

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Analgesic use in the older person

Cited by 19 publications

References 34 publications

An Algorithm for Neuropathic Pain Management in Older People

An Algorithm for Neuropathic Pain Management in Older People

Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month longitudinal prospective observational ARIZONA cohort study

Pharmacological Pain Management: For Better or for Worse?

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