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2019 | 135 | 99-115
Article title

Problems of pain treatment in the elderly in primary care

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One of the most common reasons for patients reporting to their general practitioners is pain. With increasing age, these conditions become more common in the population and are more severe. In addition to the cause of pain, the clinical picture also includes comorbidities and medications taken for this reason, as well as psychophysiological changes that occur in the body with increasing age. With the aging of society, the problem of older people's pain is becoming a growing problem. The article presents data on the characteristics of pain among seniors, the principles of its treatment and describes the most common problems associated with pain therapy.
Physical description
  • Faculty of Medicine, Wroclaw Medical University, 5, J. Mikulicza-Radeckiego Str., 50-345 Wroclaw, Poland
  • Department of Family Medicine, Wroclaw Medical University, 1, W. Syrokomli Str., 51-151 Wroclaw, Poland
  • [1] Niezabitowska E, Bartoszek A, Kucharczyk-Brus B. Organization of research for the polsenior architects and sociologists sub-project. ACEE, The Silesian University of Technology 4 (2009) 19–30.
  • [2] Edewor N, Ijiekhuamhen OP, Emeka-ukwu UP. Elderly people and their information needs. Library Philosophy and Practice 1332 (2016) 1–16.
  • [3] Gray A. The social capital of older people. Ageing and Society 29(1) (2009) 5–31.
  • [4] Abdulla A, Adams N, Bone M, Elliott A, Gaffin J, Jones D. Guidance on the management of pain in older people. Age and Ageing 42(suppl1) (2013) i1–57.
  • [5] Jones MR, Ehrhardt KP, Ripoll JG, Sharma B, Padnos IW, Kaye RJ, et al. Pain in the Elderly. Current Pain and Headache Reports 16(3) (2016) 161.
  • [6] Greist JH, Greden JF, Jefferson JW, Trivedi MH. Depression and pain. Journal of Clinical Psychiatry 69(12) (2008) 1970–8.
  • [7] Bicket MC, Mao J. Chronic Pain in Older Adults. Anesthesiology Clinics 33(3) (2015) 577–90.
  • [8] Kozak-Szkopek E, Broczek K, Slusarczyk P, Wieczorowska-Tobis K, Klich-Raczka A, Szybalska A, et al. Prevalence of chronic pain in the elderly Polish population - Results of the PolSenior study. Archives of Medical Science 13(5) (2017) 1197–206.
  • [9] Hurley AC, Volicer BJ, Hanrahan PA, Houde S, Volicer L. Assessment of discomfort in advanced Alzheimer patients. Research in Nursing & Health 15(5) (1992) 369–77.
  • [10] Sadean MR, Glass PS. Pharmacokinetics in the elderly. Best Practice & Research: Clinical Anaesthesiology 17(2) (2003) 191–205.
  • [11] Schmucker DL. Aging and the Liver: An Update. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 53A(5) (1998) B315–21.
  • [12] Abdelhafiz AH, Bailey C, Russell J, El Nahas M. Chronic kidney disease in older people: Psychiology, Pathology or Both? Nephron Clinical Practice 116 (2010) 19–24.
  • [13] Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metabolism Reviews 41(2) (2009) 67–76.
  • [14] Paladini A, Fusco M, Coaccioli S, Skaper S. Chronic Pain in the Elderly: The Case for New Therapeutic Strategies. Pain Physician 18(5) (2015) 863–76.
  • [15] Ickowicz E. Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society 57 (2009) 1331–46.
  • [16] Mahé I, Bertrand N, Drouet L, Sollier CBD, Simoneau G, Mazoyer E, et al. Interaction between paracetamol and warfarin in patients: A double-blind, placebo-controlled, randomized study. Haematologica 91(12) (2006) 1621–7.
  • [17] Marcum ZA, Hanlon JT. Recognizing the risks of chronic nonsteroidal anti-inflammatory drug use in older adults. Annals of Long-Term Care 18(9) (2010) 24–7.
  • [18] Fick D, Semla T, Steinman M. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society 67(4) (2019) 674–94.
  • [19] Schlansky B, Hwang JH. Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy. Journal of Gastroenterology 44(Suppl 19) (2009) 1724–41.
  • [20] Venerito M, Wex T, Malfertheiner P. Nonsteroidal anti-inflammatory drug-induced gastroduodenal bleeding: Risk factors and prevention strategies. Pharmaceuticals 3 (2010) 2225–37.
  • [21] Lanza FL, Chan FKL, Quigley EMM, Inadomi J, Baroni D, Bernstein D, et al. Guidelines for prevention of NSAID-related ulcer complications. American Journal of Gastroenterology 104(3) (2009) 728–38.
  • [22] Sinha M, Gautam L, Shukla PK, Kaur P, Sharma S, Singh TP. Current Perspectives in NSAID-Induced Gastropathy. Mediators of Inflammation 2013 (2013) 1–11.
  • [23] Wordliczek J, Zajączkowska R, Dziki A, Jackowski M, Richter P, Woroń J, et al. Uśmierzanie bólu pooperacyjnego w chirurgii ogólnej - zalecenia Towarzystwa Chirurgów Polskich, Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii, Polskiego Towarzystwa Badania Bólu oraz Polskiego Towarzystwa Znieczulenia Regionalnego i Leczenia. Polski Przeglad Chirurgiczny 91(1) (2019) 47–68. (Poland)
  • [24] Kohli P, Steg PG, Cannon CP, Smith SC, Eagle KA, Ohman EM, et al. NSAID use and association with cardiovascular outcomes in outpatients with stable atherothrombotic disease. American Journal of Medicine 127(1) (2014) 53–60.
  • [25] Meek IL, van de Laar MAFJ, Vonkeman HE. Non-steroidal anti-inflammatory drugs: An overview of cardiovascular risks. Pharmaceuticals 3 (2010) 2146–62.
  • [26] Ruschitzka F, Borer JS, Krum H, Flammer AJ, Yeomans ND, Libby P, et al. Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: The PRECISION-ABPM(Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) t. European Heart Journal 38(44) (2017) 3282–92.
  • [27] Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. American Family Physician 80(12) (2009) 1371–8.
  • [28] Harris RC. COX-2 and the kidney. Journal of Cardiovascular Pharmacology 47(1) (2006) 37–42.
  • [29] Auriel E, Regev K, Korczyn AD. Nonsteroidal anti-inflammatory drugs exposure and the central nervous system. Handbook of Clinical Neurology 119(1) (2014) 577–84.
  • [30] Makris UE, Abrams RC, Gurland B, Reid MC. Management of persistent pain in the older patient: A clinical review. JAMA - Journal of the American Medical Association 312(8) (2014) 825–37.
  • [31] Creamer P, Flores R, Hochberg MC. Management of osteoarthritis in older adults. Clinics in Geriatric Medicine 14(3) (1998) 435–54.
  • [32] Prostran M, Vujovic KS, Vuckovic S, Medic B, Srebro D, Divac N, et al. Pharmacotherapy of pain in the older population: The place of opioids. Frontiers in Aging Neuroscience 8(144) (2016) 1–7.
  • [33] Gallagher P, O’Mahony D. Constipation in old age. Best Practice and Research: Clinical Gastroenterology 23(6) (2009) 875–87.
  • [34] Camilleri M. Opioid-induced constipation: Challenges and therapeutic opportunities. American Journal of Gastroenterology 106(5) (2011) 835–42.
  • [35] Heiskanen T, Kalso E. Non-Analgesic Effects of Opioids: Interactions Between Opioids and Other Drugs. Current Pharmaceutical Design 18(37) (2012) 6079–89.
  • [36] Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: Consensus statement of an international expert panel with focus on the six clinically most often used world health organization step III opioids (Buprenorphine, Fentanyl, Hydromorphone, Met. Pain Practice 8(4) (2008) 287–313.
  • [37] Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet. Neurology 14(2) (2015) 162–73.
  • [38] DeBattista C. Antidepressant Agents. In: Katzung B, editor. Basic and Clinical Pharmacology. New York: McGraw-Hill Professional, 2015. p. 532–52.
  • [39] Shah RR. Drug development and use in the elderly: Search for the right dose and dosing regimen. British Journal of Clinical Pharmacology 58(5) (2004) 452–69.
  • [40] Cobert B. Cobert’s Manual of Drug Safety and Pharmacovigilance. Sudbury: World Scientific Publishing Company Pte Limited, 2019, pp. 320–364.
  • [41] Boelsterli UA. Mechanisms of NSAID-Induced Hepatotoxicity. Drug Safety 25(9) (2002) 633–48.
  • [42] Graham GG, Davies MJ, Day RO, Mohamudally A, Scott KF. The modern pharmacology of paracetamol: Therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology 21(3) (2013) 201–32.
  • [43] Tegeder I, Lötsch J, Geisslinger G. Pharmacokinetics of opiods in liver disease. Clinical Pharmacokinetics 37(1) (1999) 17–40.
  • [44] Dmochowska H. Demographic yearbook of Poland. GUS Central Statistical Office 1(1) (2014) 1–524.
  • [45] He Z, Bian J, Carretta H, Lee J, Hogan W, Shenkman E, et al. Prevalence of Multiple Chronic Conditions Among Older Adults in Florida and the United States: Comparative Analysis of the OneFlorida Data Trust and National Inpatient Sample. Journal of Medical Internet Research 20(4) (2018) e137.
  • [46] Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety 13(1) (2013) 57–65.
  • [47] Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: An 11-year national analysis. Pharmacoepidemiology and Drug Safety 19(9) (2010) 901–10.
  • [48] Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. Journal of the American Geriatrics Society 60(1) (2012) 34–41.
  • [49] Evans RS, Lloyd JF, Stoddard GJ, Nebeker JR, Samore MH. Risk factors for adverse drug events: A 10-year analysis. Annals of Pharmacotherapy 39(7–8) (2005) 1161–8.
  • [50] Davis A, Robson J. The dangers of NSAIDs: look both ways. British Journal of General Practice 66(645) (2016) 172–3.
  • [51] Davies NM, Skjodt NM. Choosing the right nonsteroidal anti-inflammatory drug for the right patient. A pharmacokinetic approach. Clinical Pharmacokinetics 38(5) (2000) 377–92.
  • [52] Floor-Schreudering A, De Smet PA, Buurma H, Kramers C, Tromp PC, Belitser S V., et al. NSAID-antihypertensive drug interactions: Which outpatients are at risk for a rise in systolic blood pressure? European Journal of Preventive Cardiology 22(1) (2015) 91–9.
  • [53] Gnjidic D, Blyth FM, Le Couteur DG, Cumming RG, McLachlan AJ, Handelsman DJ, et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) in older people: Prescribing patterns according to pain prevalence and adherence to clinical guidelines. Pain 155(9) (2014) 1814–20.
  • [54] Inturrisi CE, Jamison RN. Clinical pharmacology of opioids for pain. Clinical Journal of Pain 18(4S) (2002) S3–13.
  • [55] Mark AM, Pan DE, Johnson GE. OTC analgesics and drug interactions: Clinical implications. Osteopathic Medicine and Primary Care 2(2) (2008) 1–7.
  • [56] Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug–drug interactions with over-the-counter NSAIDs. Therapeutics and Clinical Risk Management 15(11) (2015) 1061–75.
  • [57] Overholser BR, Foster DR. Opioid pharmacokinetic drug-drug interactions. The American Journal of Managed Care 17(Suppl 11) (2011) S276-287.
  • [58] Trescot, Andrea M. M, Datta, Sukdeb M, Lee, Marion M, Hansen, Hans M. Opioid Pharmacology. Pain Physician 11(Suppl 2) (2008) S133-153.
  • [59] Fugh-Berman A. Herb-drug interactions. Lancet 355(9208) (2000) 1020.
  • [60] Hu Z, Yang X, Ho PCL, Sui YC, Heng PWS, Chan E, et al. Herb-drug interactions: A literature review. Drugs 65(9) (2005) 1239–82.
  • [61] Posadzki P, Watson L, Ernst E. Herb-drug interactions: An overview of systematic reviews. British Journal of Clinical Pharmacology 75(3) (2013) 603–18.
  • [62] Izzo AA. Herb-drug interactions: An overview of the clinical evidence. Fundamental and Clinical Pharmacology 19(1) (2005) 1–16.
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