title: Pharmacotherapy of Pain in the Older Population: The Place of Opioids.
abstract: Pain is a common symptom in older people. It is possible that pain is underreported in older persons due to an incorrect belief that it is an inevitable part of aging. Opioid analgesics are potent medications, with confirmed efficacy for the treatment of moderate to severe pain. These drugs are commonly used in older persons. However, there is insufficient evidence regarding safety of opioids in older patients. One of the reasons for this is the lack of randomized, controlled clinical trials. People of advanced age often have comorbidites and use other prescription drugs, as well as over-the-counter (OTC) compounds, thus making them more suceptible to the risk of interactions with opioids. Significant pharmacokinetic and pharmacodynamic changes that occur with advancing age increase the risk of adverse effects of opioids. There are also some discrepancies between guidelines, which recommend the use of lower doses of opioids in older patients, and the findings in the literature which suggest that pain is often undertreated in this age group. It seems that there are significant variations in the tolerability of different opioid analgesics in older people. Morphine, fentanyl, oxycodone, and buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for these patients. However, the safety and efficacy of other opioids in older patients, especially if comorbidities and polypharmacy are present, is still questionable. This review addresses the most important aspects of the use of opioids in older persons, focusing on pharmacokinetics, pharmacodynamics, adverse effects, and interactions.
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Milica
authors.initials: M
authors.lastname: Prostran
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Katarina Savić
authors.initials: KS
authors.lastname: Vujović
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Sonja
authors.initials: S
authors.lastname: Vučković
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Medić
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Srebro
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Nevena
authors.initials: N
authors.lastname: Divac
authors.affiliation: Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Radan
authors.initials: R
authors.lastname: Stojanović
authors.affiliation: Hospital for ENT, KBC Dragiša Mišović Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Vujović
authors.affiliation: Institute for Gerontology and Palliative Care Belgrade, Serbia.
authors.forename: Lepa
authors.initials: L
authors.lastname: Jovanović
authors.affiliation: Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Jotić
authors.affiliation: Clinic for Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade Belgrade, Serbia.
authors.forename: Nataša
authors.initials: N
authors.lastname: Cerovac
keywords: adverse effect; aging; older persons; opioids; pain; polypharmacy