Opiates and elderly: use and side effects

Diane L Chau, Vanessa Walker, Latha Pai, Lwin M Cho, Diane L Chau, Vanessa Walker, Latha Pai, Lwin M Cho

Abstract

The evaluation of pain and the subsequent issue of pain control is a clinical challenge that all healthcare providers face. Pain in the elderly population is especially difficult given the myriad of physiological, pharmacological, and psychological aspects of caring for the geriatric patient. Opiates are the mainstay of pain treatment throughout all age groups but special attention must be paid to the efficacy and side effects of these powerful drugs when prescribing to a population with impaired metabolism, excretion and physical reserve. In a random chart review of 300 US veterans, 44% of those receiving an analgesic also received opioids. The increasing use of opiates for pain management by healthcare practitioners requires that those prescribing opioids be aware of the special considerations for treating the elderly. This article will address the precautions one must take when using opiates in the geriatric population, as well as the side effects and ways to minimize them.

References

    1. [AGS] American Geriatrics Society. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. Sixth. New York, NY: American Geriatrics Society; 2006. pp. 140–7.
    1. [AGS] American Geriatrics Society. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50:S205–S224.
    1. [APM] Acute Pain Management Guideline Panel. Acute Pain Management: Operative or Medical Procedures and Trauma Clinical Practice Guideline. Rockville, MD: Agency for Health Care Policy and Research, US Department of Health and Human Services, Public Health Service; 1992. AHCPR Publication No. 92-0032.
    2. Hayes Bryan D., Klein-Schwartz Wendy, Barrueto Fermin., Jr Polypharmacy and the Geriatric patient. Clin Geriatr Med. 2007;23:371–390.
    1. Ballantyne JC, Mao J. Opioid therapy for chronic pain. New Engl J Med. 2003;349:1943–53.
    1. Bueno L, Fioramonti J. Action of opiates on gastrointestinal function. Baillieres Clin Gastroenterol. 1988;2:123–39.
    1. Chau DL, Mason MN. Methadone in end-of-life pain management. J Opioid Manag. 2005;1:244–8.
    1. Cherny N, Ripamonti C, Pereira J, et al. Expert Working Group of the European Association of Palliative Care Network. Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol. 2001;19:2542–54.
    1. Clark J. Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage. 2006;23:131–7.
    1. Clark PM. Pharmacologic pain management on the elderly cancer patient. Presented at the 26th Congress of the Oncology Nursing Society; May 17–20, 2001; San Diego, CA. 2001.
    1. Davies G, Kingswood C, Street M. Pharmacokinetics of opioids in renal dysfunction. Clin Pharmacokinet. 1996;31:410–22.
    1. [EPERC] End of Life/Palliative Education Resource Center. Advancing End of Life Through an Online Community of Educational Scholars. 2007. [online]. Accessed on Dec 17, 2007. URL:
    1. Ferrell BA. Managing pain and discomfort in older adults near the end of life. Annals of Long-Term Care; Presented at the American Geriatrics Society Annual Scientific Meeting; May 14, 2003; Baltimore, MD. 2003. February 2004.
    1. Furlan AD, Sandoval JA, Mailis-Gagnon A, et al. Opioids for chronic noncancer pain: a Meta-analysis of effectiveness and side effects. CMAJ. 2006;174:1589–94.
    1. Gabrail NY, Dvergsten C, Ahdieh H. Establishing the dosage equivalency of oxymorphone extended release and oxycodone controlled release in patients with cancer pain: a randomized controlled study. Curr Med Res Opin. 2004;20:911–18.
    1. Gil M, Sala M, Anguera I, et al. Qt prolongation and Torsades de Pointes in patients infected with human immunodeficiency virus and treated with methadone. Am J Cardiol. 2003;92:995–7.
    1. Gordon DB, Dahl J, Phillips P, et al. The use of “as-needed” range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society. Pain Manage Nurs. 2004;5:53–8.
    1. Guay DR. Use of oral oxymorphone in the elderly. Consult Pharm. 2007;22:417–30.
    1. Hanks G, Cherny NI, Fallon M. Opioid analgesic therapy. In: Doyle D, Hanks G, Cherny N, et al., editors. Oxford textbook of Palliative Medicine. 3. New York, NY: Oxford Univ Pr; 2005.
    1. Herr K. Chronic pain: challenges and assessment strategies. J Gerontol Nurs. 2002;28:20–7.
    1. Hughes SG. Prescribing for the elderly patient: why do we need to exercise caution? Br J Clin Pharmacol. 1998;46:531–3.
    1. Hutt E, Buffum MD, Fink R, et al. Optimizing pain management in long term care residents. Geriatrics Aging. 2007;10:523–7.
    1. Jones KR, Fink R, Pepper G, et al. Nursing home resident barriers to effective pain management: why nursing home residents in pain may not seek pain medication. J Am Med Dir Assoc. 2005;6:10–17.
    1. Krantz MJ, Kutinsky IB, Robertson AD, et al. Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes. Pharmacotherapy. 2003;23:802–5.
    1. Linnebur SA, O’Connell MB, Wessell AM, et al. Pharmacy practice, research, education, and advocacy for older adults. ACCP white paper. Pharmacotherapy. 2005;25:1404–5.
    1. McCrimmon DR, Alheid GF. On the opiate trail of respiratory depression. Am J Physiol Regul Integr Comp Physiol. 2003;285:R1274–5.
    1. Mirin SM, Meyer RE, Mendelson JH, et al. Opiate use and sexual function. Am J Psychiatry. 1980;137:909–15.
    1. Meier DE, Morrison RS, Ahronheim JC. Palliative Care. In: Duthie EH Jr, Katz PR, editors. Practice of Geriatrics. 3. Philadelphia, PA: W.B. Saunders Company; 1998.
    1. Miaskowski C, Cleary J, Burney R, et al. American Pain Society. Guideline for the Management of Cancer Pain in Adults and Children. Glenview, IL: American Pain Society; 2005.
    1. [PDR] Physicians Desk Reference. Welcome to [online] 2007. Accessed on Dec 17, 2007. URL:
    1. Tegeder I, Lötsch J, Geisslinger G. Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet. 1999;37:17–40.
    1. Thomson Thomson Healthcare [online] 2007. Accessed on Dec 17, 2007. URL:
    1. [VA/DoD] Veterans Affairs/Department of Defense. Clinical practice guideline for the management of opioid therapy for chronic pain: Medications pocket guide [online] 2007. Accessed on Dec 17, 2007. URL:
    1. Walsh TD. Oral morphine in chronic cancer pain. Pain. 1984;18:1–11.
    1. Weissman DE, Ambuel B, Hallenbeck J. Improving End-of-Life Care: A resource guide for physician education. 3. Milwaukee, WI: Medical College of Wisconsin; 1999.
    1. Weissman DE, Burchman SL, Dinndorf PA, et al. Handbook of cancer pain management. 5. Madison, WI: Wisconsin Cancer Pain Initiative; 1996.
    1. [WHO] World Health Organization. WHO’s pain ladder [online] 2006. Accessed on April 15, 2006. URL:
    1. 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;52:867–74.
    1. Yue QY, Hasselström J, Svensson JO, et al. Pharmacokinetics of codeine and its metabolites in Caucasian healthy volunteers: comparisons between extensive and poor hydroxylators of debrisoquine. Br J Clin Pharmacol. 1991;31:635–42.

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