Opioid analgesics in the pain management of geriatric patients

Overview

Opioids are an irreplaceable group of analgesics that are recommended for the treatment of moderate and severe pain according to the World Health Organization (WHO) analgesic ranking. Compared to other drug groups, they have significantly lower organ toxicity, especially when compared to non-steroidal antiphlogistic drugs, yet some typical adverse effects (AEs) must be considered. It is these that are often behind the concerns of some physicians and patients, and as a result, pain is not treated effectively enough in a significant proportion of patients. In geriatric patients, there are changes due to the aging of the body that lead to changes in the pharmacodynamics and pharmacokinetics of drugs. The basic lesson for treating elderly patients „start low, go slow“ is doubly true for opioids. With slow titration to the lowest effective dose, a large proportion of AEs can be avoided. Tolerance to some of them develops (nausea, confusion, fading), others persist throughout treatment (constipation). Patients should be made aware of the risk of these AEs, actively sought out and treated effectively. This is the only way to ensure patient confidence and cooperation to continue sufficiently effective analgesic therapy.

Keywords:

side effects – opioids – elderly patients – Analgesics – pain management