Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults

Abstract

Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients.

Evidence-Based Role of Nutrients and Antioxidants for Chronic Pain Management in Musculoskeletal Frailty and Sarcopenia in Aging

“…Managing pain in older adults is a complex task due to the high prevalence of multiple comorbidities, polypharmacy, and, in general, socio-psychological vulnerability. Moreover, drugs-related adverse events (AEs) can be potentially harmful and hardly manageable in older adults (e.g., non-steroidal anti-inflammatory drugs and opiates AEs), even though drug prescriptions are generally individualized and tailored to patients' health and social status [7]. Based on this, pain management in the elderly may be more effective when the intervention is based on a multidisciplinary method (e.g., psychological treatment, exercise program, complementary medicine, nutrition, and dietary supplementation) [8].…”

The impact of drug interactions on adverse effects of oral oxycodone in male geriatric patients

“…Pain and pain management are growing concerns among elderly patients, and the use of opioids is becoming common, with about 93% of those in residential care suffering from persistent pain . Based on the reported prevalence of opioid use in Korea, an estimated 84% of geriatric were taking opioids regularly for management of chronic pain .…”

Consensus statement on the management of breakthrough cancer pain: Assessment, treatment and monitoring recommendations

“…If, for any reason, patients do not obtain suffi cient relief, the concentration should be gradually increased until the pain is adequately controlled without side effects, with an interval of at least two hours between doses of sublingual fentanyl tablets and four hours in other fentanyl forms. In older adults, the method for trialing the opioid treatment is not exactly the same [54].…”