Treatment considerations for elderly and frail patients with neuropathic pain.
Currently, an estimated 38 million individuals 65 years or older live in the United States, and more than 11 million of these individuals are 80 years or older. Older people are at high risk of neuropathic pain because many diseases that cause neuropathic pain increase in incidence with age. Depending on their underlying health, older adults with neuropathic pain may have to cope with multiple coexisting diseases, polypharmacy, and impaired functional ability. The objective of this article is to review how aging and frailty affect the treatment of older adults with neuropathic pain. Specific topics reviewed include the complexity of treatment decisions in older patients due to aged heterogeneity, multimorbidity, and polypharmacy; selection of treatment in an effort to maximize patients' functional abilities in addition to relieving their pain; more careful dosing (usually lower) and monitoring of pharmacotherapy relative to younger patients due to age-related changes in pharmacokinetics and pharmacodynamics; and underrepresentation of older adults in clinical trials of neuropathic pain treatments, which further compromises physicians' ability to make informed treatment decisions.
Schmader
Kenneth E
KE
Department of Medicine-Geriatrics, Center for the Study of Aging, Duke University Medical Center and Geriatric Research, Durham, NC, USA. schma001@mc.duke.edu
Baron
Ralf
R
Haanpää
Maija L
ML
Mayer
John
J
O'Connor
Alec B
AB
Rice
Andrew S C
AS
Stacey
Brett
B
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D019468:Disease Management; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use; D009437:Neuralgia / Q000188:drug therapy* / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods*; D019338:Polypharmacy; D012307:Risk Factors
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009292:Narcotic Antagonists; D009294:Narcotics