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Narcotic drugs effective for severe, chronic pain in older patients

Narcotic medications can safely and effectively ease severe, chronic pain in older people with little risk that these patients will seek ever-increasing doses, UCSF medical scientists have found. Younger patients, however, are likely to want to rapidly increase their medication dose, the researchers found, posing serious potential health consequences.

The study is the first to systematically compare younger versus older patients' desires/needs to escalate the dose of opioid pain medications they take -- a class of drugs including morphine, methadone and oxycodone (sold as OxyContin, Percocet among others). Based on the new findings, the researchers suggest that the drugs may be under-prescribed for older patients, yet pose unique risks for younger patients.

Opioids have long been used for unremitting pain caused by nerve damage, arthritis and other diseases, but clinicians and patients often worry that use of the drugs will lead to patient requests for ever-increasing doses. Extended opioid use at high doses can alter immune and hormonal function and, ironically, increase pain sensitivity. The escalating drug need, stemming from "tolerance" to a given dose, also can become very costly.

The new findings show that patients 60 or older faced a much lower risk of opioid "dose escalation" than did younger patients. Older patients also received long-term pain relief from the opioids whereas younger patients showed no long-term benefit.

The discovery about opioid tolerance and age was uncovered from a study of patient records, and confirmed in animal studies. The findings are being published in two papers in the June issue of Anesthesia and Analgesia.

"We have found that older patients, often discouraged from using opioids for pain management, actually gain significant long-term relief with minimal risk of excessive dose escalation or toxicity," said Pamela Palmer, MD, PhD, professor of anesthesia at UCSF and senior author of the t
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Contact: Wallace Ravven
wravven@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
20-May-2005


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