title: Efficacy of Low-Dose Oral Liquid Morphine for Elderly Patients with Chronic Non-Cancer Pain: Retrospective Chart Review.
abstract: BACKGROUND
  The use of medications among older persons can often be challenging as physiological changes may affect metabolism and cognitive abilities. Several studies show that the elderly with chronic pain are seriously undertreated or inappropriately treated, particularly with respect to opioids.
  
  
  OBJECTIVE
  To determine whether very low doses of oral liquid morphine (LM) in patients over 65 years of age with chronic non-cancer pain provides meaningful pain improvement.
  
  
  METHODS
  A retrospective chart review was conducted for ten carefully selected older patients seen at a tertiary care pain clinic in Toronto Ontario (2009-2011) with serious biomedical painful conditions and intolerance to other opioid analgesics. Data collected included demographics, LM dosing, diagnosis and average Numeric Rating Scale (NRS) pain ratings pre- and post-administration of LM.
  
  
  RESULTS
  Of the ten eligible patients, the female/male ratio was 4:1, mean age 75.5 years and mean pain duration 7.9 years. The initial dose of LM for all patients was 1-3 mg three times/day and the maintenance dose ranged from 5 to 30 mg/day. Overall, pain ratings dropped from 6.35 to 2.95 (3.4 point drop on the NRS score) with a mean follow-up of 14 months (range 10-21).
  
  
  CONCLUSIONS
  The case series showed that carefully selected elderly patients with biomedical pathology can benefit from very low doses of LM. Future larger and well-designed studies need to focus on the use of LM for elderly patients.
authors.affiliation: Comprehensive Pain Program (CPP), Toronto Western Hospital, 750 Dundas St W., Rm. 280, 2nd Floor, Toronto, ON M6J 3S3 Canada ; Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON Canada.
authors.forename: Joyce
authors.initials: J
authors.lastname: Lee
authors.affiliation: Comprehensive Pain Program (CPP), Toronto Western Hospital, 750 Dundas St W., Rm. 280, 2nd Floor, Toronto, ON M6J 3S3 Canada ; University of Toronto Centre for the Study of Pain, Toronto, ON Canada ; Institute of Medical Sciences, University of Toronto, Toronto, ON Canada.
authors.forename: S Fatima
authors.initials: SF
authors.lastname: Lakha
authors.affiliation: Comprehensive Pain Program (CPP), Toronto Western Hospital, 750 Dundas St W., Rm. 280, 2nd Floor, Toronto, ON M6J 3S3 Canada ; University of Toronto Centre for the Study of Pain, Toronto, ON Canada ; Institute of Medical Sciences, University of Toronto, Toronto, ON Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Mailis