Pharmacological treatment of neuropathic pain in older persons

Nurmikko, Turo

doi:10.2147/cia.s1681

Cited by 27 publications

(10 citation statements)

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“…Regarding pharmacology, of the studies identified, there were a variety of pharmacologic agents used in treating pain in older adults including analgesics, psychiatric medications, and a number of adjuvant medications. However, selection of drug therapy requires an understanding of age-related pharmacodynamics and pharmacokinetic changes and needs to take into account any coexisting diseases and use of over-the-counter medications ( Haslam & Nurmikko, 2008 ; Pokela et al., 2010 ). Age-related alterations in drug distribution, excretion, and metabolism may lead to a longer duration of action and decreased or increased plasma concentration for many pain medications.…”

Section: Discussionmentioning

confidence: 99%

Chronic Pain Management Among Older Adults: A Scoping Review

Nawai

2019

SAGE Open Nursing

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Chronic pain is a significant problem for older adults. The effect of chronic pain on older people’s quality of life needs to be described and identified. For a decade, the Roy Adaptation Model has been used extensively to explain nursing phenomena and guide nursing research in several settings with several populations. The objective of this study was to use the Roy Adaptation Model to describe chronic pain and present a systematic scoping review of the literature about the middle-range theory of chronic pain among older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses model guided a scoping review search method. A literature search was undertaken using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Ovid, and ProQuest. The search terms were “chronic pain,” “pain management,” “older adult,” “Roy Adaptation Model,” and “a scope review.” The search included articles written in English published for the period of 2004–2017. All articles were synthesized using concepts of Roy’s Adaptation Model. Twenty-two studies were considered for the present review. Twenty-one articles were reports of quantitative studies, and one was a report of a qualitative study. Two outcome measures were found in this systematic scoping review. The primary outcomes reported in all articles were the reduction of pain due to interventions and an increase in coping with chronic pain. The secondary outcome measures reported in all studies were the improvement of physical function, quality of life, sleep disturbance, spiritual well-being, and psychological health related to pain management interventions among older adults. Many interventions of all studies reported improvement in chronic pain management among older adults. However, to improve chronic pain management, nurses need to understand about nursing theories, the context which instruments work, and develop empirical instruments based on the conceptual model.

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Section: Discussionmentioning

confidence: 99%

Chronic Pain Management Among Older Adults: A Scoping Review

Nawai

2019

SAGE Open Nursing

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“…Data on antineuropathic analgesic agents in the older population for GpIR raise concern regarding the same issue of relative age and pharmacodynamics. 23 Bowel absorption is altered in the elderly, multiple medications are coprescribed, and underlying physiological systems are increasingly fragile. Where comparative data exists for immediate release preparations, GpIR is generally considered safer than TCA; however, where administered as GpEn, no specific data exists.…”

Section: Safety and Tolerability Issuesmentioning

confidence: 99%

“…Where comparative data exists for immediate release preparations, GpIR is generally considered safer than TCA; however, where administered as GpEn, no specific data exists. 23 …”

Section: Safety and Tolerability Issuesmentioning

confidence: 99%

Gabapentin enacarbil extended release for the treatment of postherpetic neuralgia in adults

Thomas

Farquhar-Smith

2013

TCRM

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The development of biomedical technology is allowing refinement of drug therapies in order to improve medication profiles and benefit patients. Gabapentin (Gp) is a medication licensed globally for various indications, including postherpetic neuralgia. It has a pharmacokinetic profile which has been suggested may limit its clinical effects and reduce medication compliance. In 2012, the US Food and Drug Administration licensed a novel preparation which aims to circumvent these limitations. Gp enacarbil is a prodrug of Gp, which is additionally prepared in an extended release preparation. The resulting compound has an improved absorption profile and a reduced dosing frequency in comparison to immediate release Gp. An absence of comparative data, however, limits the direct evaluation of the medication to both immediate release and other extended release preparations available on the market. Additionally, no data are currently available addressing efficacy, tolerability, or side effects with other first line treatments of postherpetic neuralgia. Additional experimental data should be sought to clarify the position of Gp enacarbil, both within postherpetic neuralgia treatment protocols and in relation to the increasing numbers of gabapentinoids available.

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Section: Introductionmentioning

confidence: 99%

“…Although generally regarded as being well tolerated, both drugs can nevertheless induce side effects that might considerably interfere with quality of life and patient safety 2,8,9. As psychoactive compounds, their use might be associated with cognitive impairment, drowsiness, and dizziness, particularly in the elderly population 9. Consequently, they might increase the risk of falls or further aggravate the detrimental neurological effects (drowsiness, sedation, somnolence) of other centrally acting medications such as opioids, antidepressants, or sedatives 10,11.…”

Section: Introductionmentioning

confidence: 99%

<p>Pain And The Use Of Gabapentinoids In German Nursing Home Residents - Results From An Analysis Based On Statutory Health Insurance Data</p>

Bantel¹,

Hoffmann²,

Jobski³

2019

JPR

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BackgroundGabapentinoids (gabapentin and pregabalin) are psychoactive medications that are increasingly used for different conditions. Since there is evidence that psychotropic drugs, in general, are often inappropriately prescribed in elderly patients, we aimed to determine frequency and indications of gabapentinoid prescribing for nursing home residents.MethodsWe analyzed data from a large German statutory health insurance database. Included were records from people ≥65 years-of-age, who were admitted to a nursing home between January 2010 and December 2014. We determined the number and proportion of common indications for on- and off-label prescriptions, the most frequent co-medications, and the characteristics of patients and prescribers.ResultsOf 127,277 residents, 9539 (7.5%) received gabapentinoids and 4852 initiated treatment (4.0%; with 66.3% pregabalin). Median age of gabapentinoid initiators was 84 years (78.5% females). In these users, on-label prescribing was found in 57.4%, predominantly for neuropathic pain. Other painful conditions were also chief causes (84.7%) for off-label prescribing. Gabapentinoids were mainly started by general practitioners (64.5%) while pain specialists contributed <2%. Forty-six percent of users received additional opioids and in 27.5% gabapentinoids were prescribed only once.ConclusionGabapentinoids were frequently used in nursing home residents. Regular co-prescribing with opioids and psychotropic drugs might indicate employment to improve pain or assist treatment of conditions that are frequently associated with disruptive behavior such as dementia. However, more research is needed to better understand decision-making regarding gabapentinoid prescribing, especially in view of aggressive marketing, uncertain analgesic effects, problematic side effects, and uncritical use in the elderly.

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Pharmacological treatment of neuropathic pain in older persons

Abstract: . However, no particular consideration is given as to how the recommendations are applicable to the elderly population. This paper will review the guidelines in relation to this population and evaluate the existing evidence relating to the use of these drugs in older persons.

Cited by 27 publications

References 50 publications

Chronic Pain Management Among Older Adults: A Scoping Review

Chronic Pain Management Among Older Adults: A Scoping Review

Gabapentin enacarbil extended release for the treatment of postherpetic neuralgia in adults

<p>Pain And The Use Of Gabapentinoids In German Nursing Home Residents - Results From An Analysis Based On Statutory Health Insurance Data</p>

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