title: The Role of Opioid Analgesics in Geriatric Pain Management.
abstract: When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly. Finally, to assist clinicians with selecting appropriate therapy, the article concludes with an evidence-based approach to optimize opioid prescribing in older adults with CNCP.
authors.affiliation: Division of Geriatrics & Gerontology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building Suite 500, Pittsburgh, PA 15213, USA.
authors.forename: Jennifer Greene
authors.initials: JG
authors.lastname: Naples
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA, USA; Division of General Medicine, Department of Medicine, University of Pittsburgh School of Medicine, University Drive (151C), Pittsburgh, PA 15240, USA.
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.affiliation: Center for Health Equity Research and Promotion, Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building Suite 500, Pittsburgh, PA 15213, USA. Electronic address: jth14@pitt.edu.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics; D059350:Chronic Pain / Q000188:drug therapy* / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Adverse drug event; Aged; Opioid; Pharmacokinetics