RESEARCH - Narcotic painkillers work best on elderly

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Narcotic Painkillers Work Best on Elderly

By Serena Gordon

HealthDay Reporter

FRIDAY, May 20 (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. 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.

http://www.forbes.com/lifestyle/health/feeds/hscout/2005/05/20/hscout525840.html

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org