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Drugs & Aging
Erschienen in: Drugs & Aging 8/2005

01.08.2005 | Review Article

Underutilisation of Opioids in Elderly Patients with Chronic Pain

Approaches to Correcting the Problem

verfasst von: Kirsten Auret, Professor Stephan A. Schug

Erschienen in: Drugs & Aging | Ausgabe 8/2005

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Abstract

The impact of poorly managed chronic pain on the quality of life of elderly patients and the problems related to its management are widely acknowledged. Underutilisation of opioids is a major component of poor pain management in this group of patients, despite good evidence for the effectiveness of opioids and published guidelines directing their usage.
Reasons for this underutilisation are, among others, poor assessment of pain in this age group; fear of polypharmacy and opiophobia; and avoidance of opioids because of concerns about tolerance, physical dependence, addiction and adverse effects.
This review suggests approaches to overcome these barriers to opioid usage, such as regular pain assessments, education to overcome opiophobia, rational prescribing, utilisation of less conventional opioids and non-oral routes of administration, avoidance of inappropriate opioids, opioid rotation, and education about managing or preventing adverse effects, the reasons why opioid therapy may be unsuccessful, and the effects of psychological factors on the pain experience.
This more rational and knowledge-based approach to the use of opioids in the management of chronic pain in the elderly population should correct the current problems with underprescribing in this age group.
Literatur
1.
Mantyselka P, Hartikainen S, Louhivuori-Laako K, et al. Effects of dementia on perceived daily pain in home-dwelling elderly people: a population-based study. Age Ageing 2004; 33(5): 496–9PubMedCrossRef
2.
Practice guidelines for chronic pain management: a report by the American Society of Anesthesiologists Task Force on Pain Management, Chronic Pain Section. Anesthesiology 1997; 86(4): 995–1004
3.
Chodosh J, Solomon DH, Roth CP, et al. The quality of medical care provided to vulnerable older patients with chronic pain. J Am Geriatr Soc 2004; 52(5): 756–61PubMedCrossRef
4.
McClean WJ, Higginbotham NH. Prevalence of pain among nursing home residents in rural New South Wales. Med J Aust 2002; 177(1): 17–20PubMed
5.
Won AB, Lapane KL, Vallow S, et al. Persistent nonmalignant pain and analgesic prescribing patterns in elderly nursing home residents. J Am Geriatr Soc 2004; 52(6): 867–74PubMedCrossRef
6.
Donald IP, Foy C. A longitudinal study of joint pain in older people. Rheumatology (Oxford) 2004; 43(10): 1256–60CrossRef
7.
Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995; 10(8): 591–8PubMedCrossRef
8.
Griessinger N, Sittl R, Jost R, et al. The role of opioid analgesics in rheumatoid disease in the elderly population. Drugs Aging 2003; 20(8): 571–83PubMedCrossRef
9.
10.
Gloth III FM. Pain management in older adults: prevention and treatment. J Am Geriatr Soc 2001; 49(2): 188–99PubMedCrossRef
11.
Rao A, Cohen HJ. Symptom management in the elderly cancer patient: fatigue, pain, and depression. J Natl Cancer Inst Monogr 2004; (32): 150–7
12.
Juurlink DN, Herrmann N, Szalai JP, et al. Medical illness and the risk of suicide in the elderly. Arch Intern Med 2004; 164(11): 1179–84PubMedCrossRef
13.
Jakobsson U, Rahm Hallberg I, Westergren A. Pain management in elderly persons who require assistance with activities of daily living: a comparison of those living at home with those in special accommodations. Eur J Pain 2004; 8(4): 335–44PubMedCrossRef
14.
Bosley BN, Weiner DK, Rudy TE, et al. Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. J Am Geriatr Soc 2004; 52(2): 247–51PubMedCrossRef
15.
Vigano A, Bruera E, Suarez-Almazor ME. Age, pain intensity, and opioid dose in patients with advanced cancer. Cancer 1998; 83(6): 1244–50PubMedCrossRef
16.
WHO. Cancer pain relief. Geneva: World Health Organization, 1986
17.
WHO. Cancer pain relief: with a guide to opioid availability. 2nd ed. Geneva: World Health Organization, 1996
18.
Zech DF, Grond S, Lynch J, et al. Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 1995; 63(1): 65–76PubMedCrossRef
19.
Schug S, Zech D, Grond S, et al. A long-term survey of morphine in cancer pain patients. J Pain Symptom Manage 1992; 7(5): 259–66PubMedCrossRef
20.
Marinangeli F, Ciccozzi A, Leonardis M, et al. Use of strong opioids in advanced cancer pain: a randomized trial. J Pain Symptom Manage 2004; 27(5): 409–16PubMedCrossRef
21.
Buntin-Mushock C, Phillip L, Moriyama K, et al. Age-dependent opioid escalation in chronic pain patients. Anesth Analg 2005; 100: 1740–5PubMedCrossRef
22.
Kalso E, McQuay H, Wiesenfeld-Hallin Z. Opioid sensitivity of chronic noncancer pain. Seattle: IASP Press, 1999
23.
Peloso PM. Opioid therapy for osteoarthritis of the hip and knee: use it or lose it? J Rheumatol 2001; 28(1): 6–11PubMed
24.
Kalso E, Allan L, Dellemijn PL, et al. Recommendations for using opioids in chronic non-cancer pain. Eur J Pain 2003; 7(5): 381–6PubMedCrossRef
25.
Moore A, Edwards J, Barden J, et al. Bandolier’s little book of pain. Oxford: Oxford University Press, 2003
26.
Gagliese L, Jackson M, Ritvo P, et al. Age is not an impediment to effective use of patient-controlled analgesia by surgical patients. Anesthesiology 2000; 93(3): 601–10PubMedCrossRef
27.
Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 2003; 58(1): 76–81PubMedCrossRef
28.
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000; 43(9): 1905–15
29.
Ytterberg SR, Mahowald ML, Woods SR. Codeine and oxycodone use in patients with chronic rheumatic disease pain. Arthritis Rheum 1998; 41(9): 1603–12PubMedCrossRef
30.
Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain 1999; 83(3): 389–400PubMedCrossRef
31.
Duhmke RM, Cornblath DD, Hollingshead JR. Tramadol for neuropathic pain. Cochrane Database Syst Rev 2004; (2): CD003726
32.
Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352: 1324–34PubMedCrossRef
33.
Schug SA, Large RG. The use of opioids in chronic pain of non-malignant origin. Pain — Clinical Updates 1995; 3(3): 1–4
34.
Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues. J Pain Symptom Manage 1996; 11(4): 203–17PubMedCrossRef
35.
Savage SR. Opioid therapy of chronic pain: assessment of consequences. Acta Anaesthesiol Scand 1999; 43(9): 909–17PubMedCrossRef
36.
Schug SA, Ritchie JE. Use of opioids in chronic pain of nonmalignant origin. New Ethicals J 1999; 2(12): 37–41
37.
Fine PG. Difficulties and challenges in the treatment of chronic pain in the older adult. Am J Pain Manage 2004; 14(2): 2S–8S
38.
AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002; 50 (6 Suppl.): S205–24CrossRef
39.
Morgan JP. American opiophobia: customary underutilization of opioid analgesics. Adv Alcohol Subst Abuse 1985; 5: 163–73PubMedCrossRef
40.
Zenz M, Willweber-Strumpf A. Opiophobia and cancer pain in Europe. Lancet 1993; 341(8852): 1075–6PubMedCrossRef
41.
42.
McQuay HJ. Opioid clinical pharmacology and routes of administration. Br Med Bull 1991; 47(3): 703–17PubMed
43.
Schug SA, Zech D, Grond S. Adverse effects of systemic opioid analgesics. Drug Saf 1992; 7(3): 200–13PubMedCrossRef
44.
Savage SR. Assessment for addiction in pain-treatment settings. Clin J Pain 2002; 18 (4 Suppl.): S28–38PubMedCrossRef
45.
Portenoy RK. Chronic opioid therapy in nonmalignant pain. J Pain Symptom Manage 1990; 5 (1 Suppl.): S46–62PubMedCrossRef
46.
Savage SR. Long-term opioid therapy: assessment of consequences and risks. J Pain Symptom Manage 1996; 11(5): 274–86PubMedCrossRef
47.
48.
Fillastre JP, Singlas E. Pharmacokinetics of newer drugs in patients with renal impairment (Part 2). Clin Pharmacokinet 1991; 20(4): 293–310PubMedCrossRef
49.
Kilpatrick GJ, Smith TW. Morphine-6-glucuronide: actions and mechanisms. Med Res Rev. Epub 2005 Jun 10
50.
51.
Schug SA, Morgan J. Treatment of cancer pain: special considerations in patients with renal disease. Am J Cancer 2004; 3(4): 247–56CrossRef
52.
53.
Christo PJ, Grabow TS, Raja SN. Opioid effectiveness, addiction, and depression in chronic pain. Adv Psychosom Med 2004; 25: 123–37PubMedCrossRef
54.
Vainio A, Ollila J, Matikainen E, et al. Driving ability in cancer patients receiving long-term morphine analgesia. Lancet 1995; 346(8976): 667–70PubMedCrossRef
55.
Sabatowski R, Schwalen S, Rettig K, et al. Driving ability under long-term treatment with transdermal fentanyl. J Pain Symptom Manage 2003; 25(1): 38–47PubMedCrossRef
56.
Rosewarne R, Ople J, Bruce A, et al. Care needs of people with dementia and challenging behaviour living in residential facilities. Canberra: Australian Government Publishing Service, 1997
57.
Morrison RS, Siu AL. A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture. J Pain Symptom Manage 2000; 19(4): 240–8PubMedCrossRef
58.
Parmelee PA, Smith B, Katz IR. Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc 1993; 41(5): 517–22PubMed
59.
Horgas AL, Tsai PF. Analgesic drug prescription and use in cognitively impaired nursing home residents. Nurs Res 1998; 47(4): 235–42PubMedCrossRef
60.
Flaherty JH. ‘Who’s taking your 5th vital sign?’. J Gerontol A Biol Sci Med Sci 2001; 56(7): M397–9PubMedCrossRef
61.
62.
Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003; 4(1): 9–15PubMedCrossRef
63.
Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs 2004; 10(1): 6–13PubMed
64.
Closs SJ, Barr B, Briggs M, et al. A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment. J Pain Symptom Manage 2004; 27(3): 196–205PubMedCrossRef
65.
Schug S, Dunlop R, Zech D. Pharmacological management of cancer pain. Drugs 1992; 43(1): 44–53PubMedCrossRef
66.
Raffa RB, Friderichs E. The basic science aspect of tramadol hydrochloride. Pain Rev 1996; 3: 249–71
67.
Wilder-Smith C, Schimke J, Osterwalder B, et al. Oral tramadol, a mu-opioid agonist and monoamine reuptake-blocker, and morphine for strong cancer-related pain. Ann Oncol 1994; 5(2): 141–6PubMed
68.
69.
Sarhill N, Walsh D, Nelson KA. Hydromorphone: pharmacology and clinical applications in cancer patients. Support Care Cancer 2001; 9(2): 84–96PubMedCrossRef
70.
Lee MA, Leng ME, Tiernan EJ. Retrospective study of the use of hydromorphone in palliative care patients with normal and abnormal urea and creatinine. Palliat Med 2001; 15(1): 26–34PubMedCrossRef
71.
Smith MT. Neuroexcitatory effects of morphine and hydromorphone: evidence implicating the 3-glucuronide metabolites. Clin Exp Pharmacol Physiol 2000; 27(7): 524–8PubMedCrossRef
72.
Varvel JR, Shafer SL, Hwang SS, et al. Absorption characteristics of transdermally administered fentanyl. Anesthesiology 1989; 70: 928–34PubMedCrossRef
73.
Ahmedzai S, Brooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. J Pain Symptom Manage 1997; 13(5): 254–61PubMedCrossRef
74.
Christie JM, Simmonds M, Patt R, et al. Dose-titration, multicenter study of oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients using trans-dermal fentanyl for persistent pain. J Clin Oncol 1998; 16(10): 3238–45PubMed
75.
Thompson JP, Bower S, Liddle AM, et al. Perioperative pharmacokinetics of transdermal fentanyl in elderly and young adult patients. Br J Anaesth 1998; 81(2): 152–4PubMedCrossRef
76.
Corail IM, Moore AR, Strunin L. Plasma concentrations of fentanyl in normal surgical patients and those with severe renal and hepatic disease. Br J Anaesth 1980; 52: 101P
77.
Hanks G. Oral transmucosal fentanyl citrate for the management of breakthrough pain. Eur J Palliat Care 2001; 8(1): 6–9
78.
Sittl R, Griessinger N, Likar R. Analgesic efficacy and tolerability of transdermal buprenorphine in patients with inadequately controlled chronic pain related to cancer and other disorders: a multicenter, randomized, double-blind, placebo-controlled trial. Clin Ther 2003; 25(1): 150–68PubMedCrossRef
79.
Mercadante S. Opioid rotation for cancer pain: rationale and clinical aspects. Cancer 1999; 86(9): 1856–66PubMedCrossRef
80.
Bruera E, Pereira J, Watanabe S, et al. Opioid rotation in patients with cancer pain: a retrospective comparison of dose ratios between methadone, hydromorphone, and morphine. Cancer 1996; 78(4): 852–7PubMedCrossRef
81.
Thomsen AB, Becker N, Eriksen J. Opioid rotation in chronic non-malignant pain patients: a retrospective study. Acta Anaesthesiol Scand 1999; 43(9): 918–23PubMedCrossRef
82.
Quigley C. Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev 2004; (3): CD004847
83.
Lawlor PG, Turner KS, Hanson J, et al. Dose ratio between morphine and methadone in patients with cancer pain: a retrospective study. Cancer 1998; 82(6): 1167–73PubMedCrossRef
84.
85.
Latta KS, Ginsberg B, Barkin RL. Meperidine: a critical review. Am J Ther 2002; 9(1): 53–68PubMedCrossRef
86.
Li Wan Po A, Zhang WY. Systematic overview of co-proxamol to assess analgesic effects of addition of dextropropoxyphene to paracetamol. BMJ 1997; 315(7122): 1565–71PubMedCrossRef
87.
Collins SL, Edwards JE, Moore RA, et al. Single-dose dextropropoxyphene in post-operative pain: a quantitative systematic review. Eur J Clin Pharmacol 1998; 54(2): 107–12PubMedCrossRef
88.
Jensen EM, Ginsberg F. Tramadol versus dextropropoxyphene in the treatment of osteoarthritis: a short term double-blind study. Drug Invest 1994; 8(4): 211–8CrossRef
89.
Lloyd RS, Costello F, Eves MJ, et al. The efficacy and tolerability of controlled-release dihydrocodeine tablets and combination dextropropoxyphene/paracetamol tablets in patients with severe osteoarthritis of the hips. Curr Med Res Opin 1992; 13(1): 37–48PubMedCrossRef
90.
Kamal-Bahl SJ, Doshi JA, Stuart BC, et al. Propoxyphene use by community-dwelling and institutionalized elderly Medicare beneficiaries. J Am Geriatr Soc 2003; 51(8): 1099–104PubMedCrossRef
91.
Caraco Y, Sheller J, Wood AJ. Pharmacogenetic determination of the effects of codeine and prediction of drug interactions. J Pharmacol Exp Ther 1996; 278(3): 1165–74PubMed
92.
McQuay HJ, Moore RA. An evidence-based resource for pain relief. Oxford: Oxford University Press, 1998
93.
Bruera E, Sweeney C. Methadone use in cancer patients with pain: a review. J Palliat Med 2002; 5(1): 127–38PubMedCrossRef
94.
Gourlay GK, Cherry DA, Cousins MJ. A comparative study of the efficacy and pharmacokinetics of oral methadone and morphine in the treatment of severe pain in patients with cancer. Pain 1986; 25(3): 297–312PubMedCrossRef
95.
Vanegas G, Ripamonti C, Sbanotto A, et al. Side effects of morphine administration in cancer patients. Cancer Nurs 1998; 21(4): 289–97PubMedCrossRef
96.
Shorr RI, Griffin MR, Daugherty JR, et al. Opioid analgesics and the risk of hip fracture in the elderly: codeine and propoxyphene. J Gerontol 1992; 47: M111–5PubMedCrossRef
97.
Homsi J, Walsh D, Nelson KA. Psychostimulants in supportive care. Support Care Cancer 2000; 8(5): 385–97PubMedCrossRef
98.
Barkin RL, Barkin D. Pharmacologic management of acute and chronic pain: focus on drug interactions and patient-specific pharmacotherapeutic selection. South Med J 2001; 94: 756–70PubMed
99.
Ahmad M, Goucke CR. Management strategies for the treatment of neuropathic pain in the elderly. Drugs Aging 2002; 19(12): 929–45PubMedCrossRef
100.
Sjogren P, Jensen NH, Jensen TS. Disappearance of morphine-induced hyperalgesia after discontinuing or substituting morphine with other opioid agonists. Pain 1994; 59(2): 313–6PubMedCrossRef
Metadaten
Titel
Underutilisation of Opioids in Elderly Patients with Chronic Pain
Approaches to Correcting the Problem
verfasst von
Kirsten Auret
Professor Stephan A. Schug
Publikationsdatum
01.08.2005
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 8/2005
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.2165/00002512-200522080-00002

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