What medications are available for treatment of neuropathic pain? Antiepileptics, antidepressants, and opioids have all demonstrated efficacy in treatment of neuropathic pain. Various professional societies and academic groups have published recommendations for different types of neuropathic disorders based on the literature. For example, the American Academy of Neurology recommends pregabalin as first-line treatment for DPN, …
How should opioids be titrated in the elderly? Due to the extensive side effects associated with opioids, patients should be monitored closely and frequently for efficacy and side effects. Opioids should be started low and titrated slowly, taking into account kidney and liver function. When starting an opioid, it is recommended to start an immediate …
Do opioid concerns differ in the elderly? In general, opioid tolerance is less likely to set in the elderly compared to younger people. As such, it is not unusual to observe elderly individuals with chronic pain on stable doses of opioids for years. While elder individuals with chronic pain often cite fear of addiction for …
What are the opioid considerations for patients with hepatic and renal dysfunction? With hepatic and renal dysfunction being common comorbidities in the elderly, it is essential to take into the account the severity of dysfunction when prescribing opioids. Hydromorphone, oxycodone, and methadone metabolism is dependent on the function of the liver and should therefore be …
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What opioid pharmacologic agents are available? Patients with moderate to severe pain or pain related functional impairment not controlled with non-opioids should be considered for opioid therapy. Typically milder and short-acting opioids are attempted prior to the use of stronger opioids. These consist usually of oxycodone, hydrocodone, and tramadol. Tramadol, a weak opioid agonist and …
What are pharmacologic adjuvants, and which are used in the treatment of chronic pain? Pharmacologic adjuvants are medications used as analgesics that were originally developed for other indications. These are commonly used in conjunction with analgesics for chronic and refractory pain. Most commonly, antiepileptics, antidepressants, corticosteroids, local anesthetics, and muscle relaxants are used in pain. …
What non opioid pharmacological agents are available for the elderly? Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common non-opioid pain medications prescribed. Acetaminophen potentiates the effects of opioids and is therefore a useful co-analgesic; however, it does have a ceiling effect, and therefore dose escalation is limited. It is metabolized by the liver …
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