Underutilisation of Opioids in Elderly Patients with Chronic Pain
- 1 January 2005
- journal article
- review article
- Published by Springer Science and Business Media LLC in Drugs & Aging
- Vol. 22 (8), 641-654
- https://doi.org/10.2165/00002512-200522080-00002
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.Keywords
This publication has 92 references indexed in Scilit:
- A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairmentJournal of Pain and Symptom Management, 2004
- Analgesic Drug Prescription and Use in Cognitively Impaired Nursing Home ResidentsNursing Research, 1998
- Drug Dosage in the ElderlyDrugs & Aging, 1998
- Transdermal fentanyl versussustained-release oral morphine in cancer pain: Preference, efficacy, and quality of lifeJournal of Pain and Symptom Management, 1997
- Long-term opioid therapy: Assessment of consequences and risksJournal of Pain and Symptom Management, 1996
- Opioid therapy for chronic nonmalignant pain: a review of the critical issuesJournal of Pain and Symptom Management, 1996
- Pain in cognitively impaired nursing home patientsJournal of Pain and Symptom Management, 1995
- Adverse Effects of Systemic Opioid AnalgesicsDrug Safety, 1992
- Pharmacological Management of Cancer PainDrugs, 1992
- Pharmacokinetics of Newer Drugs in Patients with Renal Impairment (Part I)Clinical Pharmacokinetics, 1991