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Narcotic Painkillers Work Best on Elderly

May 21, 2005

Unlike younger patients, there’s little need to increase dose

HealthDay News — Daily aches and discomfort may become more common with age, but elderly Americans shouldn’t have to increase their dosage of narcotic pain relievers to keep up with the pain, researchers report.

On the other hand, people under 50 years of age may need to ramp up their dosage of these opioid pain-relieving medicines — drugs like morphine, OxyContin and Percocet — to achieve ongoing relief, reports a study in the June issue of Anesthesia & Analgesia.

“Opioids are very safe if they’re used and dosed appropriately. The elderly should realize that these are very viable options for severe pain and they shouldn’t worry so much about the stigma attached to these drugs,” said researcher Dr. Pamela P. Palmer, professor of anesthesia and director of the pain management center at the University of California, San Francisco.

“Older people won’t have to escalate their dose much,” Palmer added. “However, tolerance is a very real issue in younger patients. Daily chronic use of opioids in young patients may not be getting them anywhere in the long run because our data shows that the average pain score was not improved” with a higher dose.

Currently, one in five older Americans uses pain-relieving medications daily, according to the National Institute of Neurological Disorders and Stroke.

Palmer said the researchers started the study because they noticed their younger patients seemed to rapidly need more medication, while the older ones didn’t.

To test these anecdotal observations, Palmer’s group reviewed medical records from 206 people treated for non-cancer-related pain for two years. The pain was caused by either nerve damage, arthritis or fibromyalgia.

A total of 104 participants were under 50 years of age, while 102 were over 60 years. The researchers deliberately left out people in the 50 to 60 age group because they may fall somewhere in the middle when it comes to pain medicine.

Both groups reached their maximum dose of medication after about 14 to 15 months. However, the maximum dose for the older group was less than half what it was for the younger people — 211 milligrams per day versus 452 mg/d, respectively.

“The most fascinating finding was that the older group continued to have pain relief. In fact, they had a statistically significant drop in pain scores from the start of the study to two years after,” said Palmer.

In contrast, “the younger group, who had escalated their doses of medication, showed no statistical difference in pain relief.”

In addition to this study in humans, the researchers also tested opioids on both young and old rats. They found that tolerance to opioids developed more quickly in the younger rats.

“The rat study backed up the human study,” said Palmer.

It’s commonly believed that older people need lower doses because they metabolize the drugs and excrete them more slowly. But Palmer said current studies point instead to molecular changes in the way the cells recognize these drugs. She explained that some of the same molecules that are important opioid receptors are also important to memory.

So, the good news is that “while you may forget where you put your keys as you age, your molecules forget that they’ve been exposed to opioids,” she said, and so individuals don’t develop a tolerance to these drugs as they enter old age.

Dr. Angela Stroe, a pain management specialist at Long Island Care Center in Flushing, N.Y., said she wasn’t surprised by the study’s findings. She believes there are a number of reasons why older people might not need as high a dose of narcotic medications.

One factor may be that “older people aren’t as active as younger people and may not have as much pain, because they’re not moving around as much,” said Stroe.

She also suggests that it’s important to get treatment for pain, whether from narcotics, other medications, or other treatment options. Don’t wait more than three to six months before asking for a referral to a pain management specialist, Stroe said.

“If you have pain, you need to figure out why you have it and address it right away. There’s no need to be in pain and suffering,” said Stroe.

More information

University of California, San Francisco

To learn more about chronic pain, visit the National Institute of Neurological Disorders and Stroke.




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