Therapeutic Advances
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2017; 5(3): 73-81
Published online Mar 16, 2017. doi: 10.12998/wjcc.v5.i3.73
Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults
Fabio Guerriero
Fabio Guerriero, Department of Internal Medicine and Therapeutics, Section of Geriatrics, University of Pavia, 27100 Pavia, Italy
Author contributions: This manuscript was written completely by the stated author.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabio Guerriero, MD, PhD, Department of Internal Medicine and Therapeutics, Section of Geriatrics, University of Pavia, via Emilia 12, 27100 Pavia, Italy. fabio.guerriero01@universtitadipavia.it
Telephone: +39-0382-381772 Fax: +39-0382-381218
Received: July 11, 2016
Peer-review started: July 14, 2016
First decision: September 12, 2016
Revised: October 25, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: March 16, 2017
Abstract

Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients.

Keywords: Chronic pain, Opioids, Pain management, Elderly

Core tip: Persistent pain (pain that lasts more than three months) is a common issue in older adults. Pain management requires a multidisciplinary approach and the knowledge of analgesic drugs is fundamental for effective and safe outcomes. Current guidelines for geriatric patients recommend opioid-use as a first-line agent for moderate-to-severe persistent pain. However some concerns about opioid-use in this age-group are present. Nevertheless opioid epidemic needs attention for safe prescribing. This manuscript addresses to data that will likely help to improve the competence on opioids use and the likelihood of a successful analgesic trial in older adults.