In addition, long-term use of opioids at moderate levels does not pose an increased risk for cardiac or kidney damage or gastric ulcers, as some Cox-2 inhibitors do -- a risk of greater concern for older patients than younger ones, Palmer said. Sedation and constipation are the main opioid side effects, but these can be managed by modifying the selection of the opioid, the dosage and proper bowel medications.
Researchers examined the medical records of 206 patients who had been treated for two years for severe, non-cancer-related pain, either from nerve damage (called neuropathic pain) or from arthritis, fibromyalgia and related conditions that cause what is known as nociceptive pain. Patients were divided into younger (less than 50 years old) and older (over 60) age groups.
The records showed that both groups started with similar doses of morphine-like drugs and both took about 14 to 15 months to reach their peak dose. But the average peak dose of the younger group was more than twice that of the older group. In many cases, peak doses for younger patients were well over half a gram per day of morphine or related opioid.
Younger patients with nociceptive pain escalated the drug dosage at a "tremendous rate" for more than a year, the researchers report. Yet they did not achieve any long-term pain relief from these high doses according to standard self-assessment scores. In contrast, the older patients, with less than half the dose escalation, reported significant relief from pain, the scientists found.
The researchers speculate that the difference between the older and younger patients may be the result of molecular changes in neurons that occur with aging, and they cite this as a particularly important area for future research. They also recognize the importance of a prospective study rather than a retrospective one, and they are planning a follow-up study.
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Contact: Wallace Ravven
wravven@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
20-May-2005