Safety and Efficacy Considerations of Gabapentin as Adjunctive Therapy to Opioids in the Perioperative Setting for Older Adults

2020 ◽  
Vol 35 (10) ◽  
pp. 436-438
Author(s):  
Edgar Garcia ◽  
Justin P. Reinert ◽  
Michael Veronin
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Older Adult ◽  
Adjunctive Therapy ◽  
Adult Patients ◽  
Opioid Epidemic ◽  
Safety And Efficacy ◽  
Initial Choice

While opioids have historically been the initial choice of analgesic for both acute and chronic pain, legislative and deprescribing trends as a result of the opioid epidemic have demonstrated an increase in the use of adjunctive therapies. These adjunctive agents are being utilized with increased frequency, especially in older adult patients, as a mechanism to mitigate any likelihood of dependency and in an effort to provide multimodal pain management. As this patient population can be more challenging because of comorbidities, the presence of polypharmacy, pharmacokinetic, and pharmacodynamic changes, it is important to evaluate the risk of any relevant adverse effects for opioids and adjuncts that can lead to higher risk of opioid toxicities. Gabapentin is one of the most commonly added adjunctive medications; however, its safety and efficacy in conjunction with opioids has not been exclusively considered in older adult patients in the perioperative setting. This report will summarize available evidence for gabapentin as an adjunctive therapy to opioids in older adult patients undergoing surgery.

Safety and Efficacy Considerations of Gabapentin as Adjunctive Therapy to Opioids in the Perioperative Setting for Older Adults

2020 ◽  
Vol 35 (10) ◽  
pp. 436-438
Author(s):  
Edgar Garcia ◽  
Justin P. Reinert ◽  
Michael Veronin
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Older Adult ◽  
Adjunctive Therapy ◽  
Adult Patients ◽  
Opioid Epidemic ◽  
Safety And Efficacy ◽  
Initial Choice

While opioids have historically been the initial choice of analgesic for both acute and chronic pain, legislative and deprescribing trends as a result of the opioid epidemic have demonstrated an increase in the use of adjunctive therapies. These adjunctive agents are being utilized with increased frequency, especially in older adult patients, as a mechanism to mitigate any likelihood of dependency and in an effort to provide multimodal pain management. As this patient population can be more challenging because of comorbidities, the presence of polypharmacy, pharmacokinetic, and pharmacodynamic changes, it is important to evaluate the risk of any relevant adverse effects for opioids and adjuncts that can lead to higher risk of opioid toxicities. Gabapentin is one of the most commonly added adjunctive medications; however, its safety and efficacy in conjunction with opioids has not been exclusively considered in older adult patients in the perioperative setting. This report will summarize available evidence for gabapentin as an adjunctive therapy to opioids in older adult patients undergoing surgery.

scholarly journals Unintended Consequences of Opioid Regulations in Older Adults with Multiple Chronic Conditions

2020 ◽  
Vol 60 (7) ◽  
pp. 1343-1352 ◽  
Author(s):  
Christine S Ritchie ◽  
Sarah B Garrett ◽  
Nicole Thompson ◽  
Christine Miaskowski
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Pain Management ◽  
Chronic Conditions ◽  
Unintended Consequences ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Opioid Epidemic ◽  
Management Options ◽  
Policy Responses

Abstract Background and Objectives The opioid epidemic has led to substantive regulatory and policy changes. Little is known about how these changes have impacted older adults, especially those with chronic pain and multiple chronic conditions (MCC). We sought to understand the experiences of older adults with chronic pain and MCC in the context of the opioid epidemic and policy responses to it. Research Design and Methods Purposive sampling of older adults in a West Coast metropolitan area. Semistructured in-depth interviews lasting 45–120 min were digitally recorded and transcribed. Responses were analyzed using the constant comparative method. Participants were 25 adults aged 65 years and greater with three or more self-reported medical conditions and pain lasting for more than 6 months. Results Respondents’ accounts revealed numerous unintended consequences of the opioid epidemic and its policy responses. We identified four main themes: changes to the patient–clinician relationship; lack of patient agency and access in pain management; patient ambivalence and anxiety about existing opioid treatment/use; and patient concerns about future use. Discussion and Implications Older adults have high rates of chronic pain and MCC that may reduce their pain management options. The opioid epidemic and policies addressing it have the potential to negatively affect patient–clinician relationships and patients’ pain self-management. Clinicians may be able to mitigate these unintended consequences by actively conveying respect to the patient, empowering patients in their pain self-management activities, and proactively addressing worries and fears patients may own related to their current and future pain management regimens.

scholarly journals PSYCHOSOCIAL AND CULTURAL PAIN EXPERIENCES AND SELF-MANAGEMENT ACROSS DIVERSE OLDER ADULT POPULATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S70-S70
Author(s):  
Staja Booker ◽  
Keesha Roach
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Older Adult ◽  
Bodily Pain ◽  
Cultural Factors ◽  
Qualitative Inquiry ◽  
Mediating Effect ◽  
Self Management ◽  
Osteoarthritis Pain ◽  
Racial Ethnic

Abstract Racial/ethnic minority older adults experience a disproportionate burden of functionally-disabling chronic pain. However, minimal research in pain and aging has fully explicated the unique and endemic psychosocial and cultural factors that strongly influence appraisal, communication, and management/coping of pain. Yet, to fully engage with and care for diverse racial/ethnic older adults, intentional responsiveness to these factors is necessary. This symposium features under-represented racial/ethnic older adult populations and multiple methodologies, including advanced imaging techniques, to understand various psychosocial and cultural factors associated with chronic pain. Our first presenter, Dr. Lor, uses qualitative inquiry to examine pain-associated language and expression of pain in Hmong older adults, which is often laden with stress and misunderstanding. Following is Dr. Taylor who will discuss the mediating effect of stress and coping on bodily pain in inner-city Black older adults. Dr. Terry will present novel findings on the association between catastrophizing (i.e., negative cognitive and emotional response to actual or anticipated pain resulting in feelings of helplessness) and brain structure in non-Hispanic Black and White adults with or at high-risk for knee osteoarthritis pain. This presentation will segway into culturally-relevant pain self-management practices and the role of social support specifically for Blacks from urban Detroit, as presented by Dr. Janevic. We will conclude with Dr. Booker presenting mixed-level data on the lack of familial and social networks and provider support for osteoarthritis pain self-management in Southern-dwelling older Blacks. This symposium extends the knowledge on the nuanced complexity of biopsychosocial and cultural dynamics underlying the pain experience.

CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3199-3204 ◽  
Author(s):  
Chrysanthi Batistaki ◽  
Eleni Chrona ◽  
Andreas Kostroglou ◽  
Georgia Kostopanagiotou ◽  
Maria Gazouli
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Cyp2d6 Genotype ◽  
Chronic Pain Patients ◽  
Reduction Of Pain ◽  
Pain Patients ◽  
Numeric Rating

Abstract Objective To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. Design Prospective cohort study. Setting General hospital, pain management unit. Subjects Patients with chronic pain, treated with codeine or tramadol. Methods Patients’ pain was assessed at baseline (numeric rating scale [NRS]; 0–10). Prescription of codeine or tramadol was selected randomly. The assessment of patients’ response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients’ blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). Results Seventy-six consecutive patients were studied (20 males, 56 females), aged 21–85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). Conclusions Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.

scholarly journals Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults

Pain Medicine ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. e68-e78 ◽  
Author(s):  
Mary R Janevic ◽  
Varick Shute ◽  
Susan L Murphy ◽  
John D Piette
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
African American ◽  
Pain Management ◽  
Feasibility Trial ◽  
Chronic Pain Management ◽  
Step Counts ◽  
African American Adults ◽  
Activity Trackers ◽  
Wearable Activity Trackers

Abstract Background Wearable activity trackers may facilitate walking for chronic pain management. Objective We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity. Design Randomized controlled pilot and feasibility trial. Subjects Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls). Methods Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration. Results More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls. Conclusions With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.

Sign in / Sign up

Export Citation Format

Share Document