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Review
. 2016 Nov;32(4):725-735.
doi: 10.1016/j.cger.2016.06.006. Epub 2016 Aug 9.

The Role of Opioid Analgesics in Geriatric Pain Management

Jennifer Greene Naples  1 , Walid F Gellad  2 , Joseph T Hanlon  3
Affiliations
Review

The Role of Opioid Analgesics in Geriatric Pain Management

Jennifer Greene Naples et al. Clin Geriatr Med. 2016 Nov.

Abstract

When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly. Finally, to assist clinicians with selecting appropriate therapy, the article concludes with an evidence-based approach to optimize opioid prescribing in older adults with CNCP.

Keywords: Adverse drug event; Aged; Opioid; Pharmacokinetics.

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Figures

Figure 1
Figure 1
Adjusted relative risk ratios for incident delirium. Abbreviations: IV = intravenous; ME = morphine equivalents.
Figure 2
Figure 2
Additional adverse drug events associated with opioid use among older adults.,– Abbreviations: MVA = motor vehicle accident; CV = cardiovascular event; AF = atrial fibrillation; MI = myocardial infarction; PNA = pneumonia.
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