Pain Management Nursing
Volume 11, Issue 2, Supplement , Pages S11-S22 , June 2010

Balancing Analgesic Efficacy with Safety Concerns in the Older Patient

  • Paul Arnstein, RN, PhD

      Affiliations

    • Corresponding Author InformationAddress correspondence to Paul Arnstein, Clinical Nurse Specialist for Pain Relief, Massachusetts General Hospital, Boston, MA.

Received 13 October 2009 ,Revised 29 October 2009 ,Accepted 14 February 2010.

References 

  1. Adams M, Pieniaszek HJ, Gammaitoni AR, Ahdieh H. Oxymorphone extended release does not affect CYP2C9 or CYP3A4 metabolic pathways. Journal of Clinical Pharmacology. 2005;45(3):337–345
  2. , Administration on Aging & United States Department of Health and Human Services (2007). A profile of older americans: 2007. Retrieved October 27, 2009, from http://www.agingcarefl.org/aging/AOA-2007profile.pdf
  3. American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society. 2009;57(8):1331–1346
  4. American Geriatrics Society Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. Journal of the American Geriatrics Society. 2002;50(6 Suppl):S205–S224
  5. American Pain Society. Principles of analgesic use in the treatment of acute pain and cancer pain. 6th ed.. Glenview, IL: APS Press; 2008;
  6. Amir R, Argoff CE, Bennett GJ, Cummins TR, Durieux ME, Gerner P, et al. The role of sodium channels in chronic inflammatory and neuropathic pain. The Journal of Pain. 2006;7(5 Suppl 3):S1–29
  7. Argoff CE, Galer BS, Jensen MP, Oleka N, Gammaitoni AR. Effectiveness of the lidocaine patch 5% on pain qualities in three chronic pain states: Assessment with the Neuropathic Pain Scale. Current Medical Research and Opinion. 2004;20(Suppl 2):21–28
  8. Barbano RL, Herrmann DN, Hart-Gouleau S, Pennella-Vaughan J, Lodewick PA, Dworkin RH. Effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in diabetic polyneuropathy. Archives of Neurology. 2004;61(6):914–918
  9. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Archives of Internal Medicine. 1997;157(14):1531–1536
  10. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of Internal Medicine. 1991;151(9):1825–1832
  11. Blandizzi C, Tuccori M, Colucci R, Gori G, Fornai M, Antonioli L, et al. Clinical efficacy of esomeprazole in the prevention and healing of gastrointestinal toxicity associated with NSAIDs in elderly patients. Drugs & Aging. 2008;25(3):197–208
  12. Burch F, Codding C, Patel N, Sheldon E. Lidocaine patch 5% improves pain, stiffness, and physical function in osteoarthritis pain patients. A prospective, multicenter, open-label effectiveness trial. Osteoarthritis and Cartilage. 2004;12(3):253–255
  13. Chan FK, Wong VW, Suen BY, Wu JC, Ching JY, Hung LC, et al. Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: A double-blind, randomised trial. Lancet. 2007;369(9573):1621–1626
  14. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal of Pain. 2009;10(2):113–130
  15. Cooper C, Jordan KM. Topical NSAIDs in osteoarthritis. British Medical Journal. 2004;329(7461):304–305
  16. Cryer B, Goldschmiedt M, Redfern JS, Feldman M. Comparison of salsalate and aspirin on mucosal injury and gastroduodenal mucosal prostaglandins. Gastroenterology. 1990;99(6):1616–1621
  17. Di Rienzo Businco L, Di Rienzo Businco A, D'Emilia M, Lauriello M, Coen Tirelli G. Topical versus systemic diclofenac in the treatment of temporo-mandibular joint dysfunction symptoms. Acta Otorhinolaryngologica Italica. 2004;24(5):279–283
  18. Edwards RR. Age-associated differences in pain perception and pain processing. In:  Gibson SJ,  Weiner DK editor. Pain in older persons. Seattle: IASP Press; 2005;p. 45–65
  19. Endo Pharmaceuticals (2006). Opana IR prescribing information. Retrieved June 29, 2009, from http://www.endo.com/pdf/products/opana_ir_pi.pdf
  20. Ferrini R, Paice JA. How to initiate and monitor infusional lidocaine for severe and/or neuropathic pain. The Journal of Supportive Oncology. 2004;2(1):90–94
  21. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Archives of Internal Medicine. 2003;163(22):2716–2724
  22. Fine PG, Portenoy RK. A clinical guide to opioid analgesia. New York: Vendome Group; 2007;
  23. Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Medicine (Malden, Mass.). 2008;9(4):444–459
  24. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Can patients taking opioids drive safely? A structured evidence-based review. Journal of Pain & Palliative Care Pharmacotherapy. 2002;16(1):9–28
  25. Gagliese L, Farrell MJ. The neurobiology of aging, nociception, and pain: An integration of human and experimental evidence. In:  Gibson SJ,  Weiner DK editor. Pain in older persons. Seattle: IASP Press; 2005;p. 25–44
  26. Gagliese L, Melzack R. Age differences in nociception and pain behaviours in the rat. Neuroscience and Biobehavioral Reviews. 2000;24(8):843–854
  27. Galer BS, Gammaitoni AR, Oleka N, Jensen MP, Argoff CE. Use of the lidocaine patch 5% in reducing intensity of various pain qualities reported by patients with low-back pain. Current Medical Research and Opinion. 2004;20(Suppl 2):S5–12
  28. Galer BS, Jensen MP, Ma T, Davies PS, Rowbotham MC. The lidocaine patch 5% effectively treats all neuropathic pain qualities: Results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the neuropathic pain scale. The Clinical Journal of Pain. 2002;18(5):297–301
  29. Gammaitoni AR, Alvarez NA, Galer BS. Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: A review of the literature. Journal of Clinical Pharmacology. 2003;43(2):111–117
  30. Gimbel J, Linn R, Hale M, Nicholson B. Lidocaine patch treatment in patients with low back pain: Results of an open-label, nonrandomized pilot study. American Journal of Therapeutics. 2005;12(4):311–319
  31. Green JL, Hawley JN, Rask KJ. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population?. The American Journal of Geriatric Pharmacotherapy. 2007;5(1):31–39
  32. Griffin MR. Epidemiology of nonsteroidal antiinflammatory drug–associated gastrointestinal injury. The American Journal of Medicine. 1998;104(3A):23S–29Sdiscussion 41S-42S
  33. Hanlon JT, Aspinall SL, Semla TP, Weisbord SD, Fried LF, Good CB, et al. Consensus guidelines for oral dosing of primarily renally cleared medications in older adults. Journal of the American Geriatrics Society. 2009;57(2):335–340
  34. Hanlon JT, Schmader KE, Koronkowski MJ, Weinberger M, Landsman PB, Samsa GP, et al. Adverse drug events in high risk older outpatients. Journal of the American Geriatrics Society. 1997;45(8):945–948
  35. Harris JD. Management of expected and unexpected opioid-related side effects. The Clinical Journal of Pain. 2008;24(Suppl 10):S8–S13
  36. Hemstapat K, Monteith GR, Smith D, Smith MT. Morphine-3-glucuronide's neuro-excitatory effects are mediated via indirect activation of N-methyl-D-aspartic acid receptors: Mechanistic studies in embryonic cultured hippocampal neurones. Anesthesia and Analgesia. 2003;97(2):494–505
  37. Heyneman CA, Lawless-Liday C, Wall GC. Oral versus topical NSAIDs in rheumatic diseases: A comparison. Drugs. 2000;60(3):555–574
  38. , Information Centre (Health Care) (2007). Prescriptions dispensed in the community statistics for 1996 to 2006: England. Retrieved July 3, 2009, from http://www.parliament.uk/deposits/depositedpapers/2008/DEP2008-0875.pdf
  39. Johnson, S.J. (2007). Opioid safety in patients with renal or hepatic dysfunction. Retrieved October 27, 2009, from Pain Treatment Topics Web site: http://pain-topics.org/pdf/Opioids-Renal-Hepatic-Dysfunction.pdf
  40. Kamal-Bahl SJ, Stuart BC, Beers MH. Propoxyphene use and risk for hip fractures in older adults. The American Journal of Geriatric Pharmacotherapy. 2006;4(3):219–226
  41. Katz N. The impact of opioids on the endocrine system. Pain Management Rounds. 2005;1(9):
  42. Katz NP, Adams EH, Benneyan JC, Birnbaum HG, Budman SH, Buzzeo RW, et al. Foundations of opioid risk management. The Clinical Journal of Pain. 2007;23(2):103–118
  43. Lanza F, Rack MF, Doucette M, Ekholm B, Goldlust B, Wilson R. An endoscopic comparison of the gastroduodenal injury seen with salsalate and naproxen. The Journal of Rheumatology. 1989;16(12):1570–1574
  44. Laverty D. Treating cancer-related breakthrough pain: The oral transmucosal route. International Journal of Palliative Nursing. 2007;13(7):326–331
  45. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies. Journal of the American Medical Association. 1998;279(15):1200–1205
  46. Lussier D, Portenoy RK. Adjuvant analgesics. In:  Doyle D,  Hanks G,  Cherny NI,  Calman K editor. Oxford Textbook of Palliative Medicine. 3d ed.. Oxford: Oxford University Press; 2004;p. 349–377
  47. Lynch ME, Watson CP. The pharmacotherapy of chronic pain: A review. Pain Research & Management. 2006;11(1):11–38
  48. Meier T, Wasner G, Faust M, Kuntzer T, Ochsner F, Hueppe M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: A randomized, double-blind, placebo-controlled study. Pain. 2003;106(1-2):151–158
  49. Milton JC, Hill-Smith I, Jackson SH. Prescribing for older people. BMJ. 2008;336(7644):606–609
  50. Ong CK, Lirk P, Tan CH, Seymour RA. An evidence-based update on nonsteroidal antiinflammatory drugs. Clinical Medicine & Research. 2007;5(1):19–34
  51. Patrono C, Garcia Rodriguez LA, Landolfi R, Baigent C. Low-dose aspirin for the prevention of atherothrombosis. The New England Journal of Medicine. 2005;353(22):2373–2383
  52. Perucca E. Clinical pharmacokinetics of new-generation antiepileptic drugs at the extremes of age. Clinical Pharmacokinetics. 2006;45(4):351–363
  53. Rogers JF, Nafziger AN, Bertino JS. Pharmacogenetics affects dosing, efficacy, and toxicity of cytochrome P450-metabolized drugs. The American Journal of Medicine. 2002;113(9):746–750
  54. Schmucker DL. Liver function and phase I drug metabolism in the elderly: A paradox. Drugs & Aging. 2001;18(11):837–851
  55. Stamer UM, Stuber F. Genetic factors in pain and its treatment. Current Opinion in Anaesthesiology. 2007;20(5):478–484
  56. Stanos SP. Biopsychosocial assessment for chronic opioid use. Pain Management Nursing. 2007;8(3 Suppl 1):S14–S22
  57. Strassels SA, McNicol E, Suleman R. Pharmacotherapy of pain in older adults. Clinics in Geriatric Medicine. 2008;24(2):275–298vi-vii
  58. U.S. Food and Drug Administration (2006). Ibuprofen can interfere with aspirin's antiplatelet effect. Patient safety news #57. Retrieved September 2, 2009, from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=57
  59. U.S. Food and Drug Administration (2008). Information for healthcare professionals: Suicide behavior and ideation and antiepileptic drugs. Retrieved July 6, 2009, from http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm100192.htm
  60. Vaile JH, Davis P. Topical NSAIDs for musculoskeletal conditions. A review of the literature. Drugs. 1998;56(5):783–799
  61. Wiffen PJ, McQuay HJ, Edwards JE, Moore RA. Gabapentin for acute and chronic pain. Cochrane Database of Systematic Reviews(3). 2005;CD005452
  62. Wirth JH, Hudgins JC, Paice JA. Use of herbal therapies to relieve pain: A review of efficacy and adverse effects. Pain Management Nursing. 2005;6(4):145–167
  63. Wynne H. Drug metabolism and ageing. The Journal of the British Menopause Society. 2005;11(2):51–56

 STATEMENT OF CONFLICT OF INTEREST: Paul Arnstein, RN, PhD, has been paid consultant fees in the past 2 years as a Clinical (content) advisor for King Pharmaceuticals, Cephalon Pharmaceuticals, PriCara division of Ortho McNeil, Inflexxion, American Pain Foundation, the Foundation of Informed Medical Decision Making, the Nurse Practitioner Healthcare Foundation and independent education companies.Publication of this article was supported by Endo Pharmaceuticals Inc.

PII: S1524-9042(10)00034-2

doi: 10.1016/j.pmn.2010.03.003

Pain Management Nursing
Volume 11, Issue 2, Supplement , Pages S11-S22 , June 2010

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