Opioids for noncancer pain in the elderly

• Published in: Schmerz (Berlin, Germany) Vol. 29; no. 4; pp. 380 - 401
• Main Authors: Schuler, M, Grießinger, N
• Format: Journal Article
• Language: German
• Published: Germany 01.08.2015
• Subjects: Aged; Aged, 80 and over; Chronic Pain - drug therapy; Chronic Pain - etiology; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Interactions; Guideline Adherence; Humans; Kidney Function Tests; Liver Function Tests; Narcotics - adverse effects; Narcotics - therapeutic use; Pain Management - methods; Patient Education as Topic; Delirium; Adverse effects, drugs; Accidental fall; Geriatrics; Multimorbidity
• ISSN: 1432-2129
• DOI: 10.1007/s00482-015-0029-x

Opioids are increasingly used in the elderly. Side effects differ compared to other analgesics. In this review article, special aspects about using opioids for noncancer pain in older people and in geriatric patients are identified. So far randomized controlled trials for the indication of and comparison between various opioids have been performed in middle-aged patients and not exclusively in geriatric patients or elderly (> 75 years). Furthermore, the evidence for multimorbid elderly patients with respect to side effects is also very poor. The indication for opioid therapy should be narrow. The patient and their caregivers must be provided patient information regarding opioid therapy. The principle "start low, go slow" is highly recommended. To reduce the risk of falls, longer acting opioids should be used and short acting opioids should be avoided. Everyday relevant negative effects on cognition are possible in opioid use and have to be observed. As recommended in the recently published German guideline for long-term use of opioids in noncancer pain a critical check after 3 months and in case of dosing over 120 mg morphine equivalents is advisable, especially for older patients. Liver and kidney function and drug interactions have to be taken into consideration like in every age group.