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Pain in the frail or elderly patient: does tapentadol have a role?

Citation

Veal, FC and Peterson, GM, Pain in the frail or elderly patient: does tapentadol have a role?, Drugs and Aging, 32, (6) pp. 419-426. ISSN 1170-229X (2015) [Refereed Article]

Copyright Statement

Copyright 2015 Springer International Publishing Switzerland

DOI: doi:10.1007/s40266-015-0268-7

Abstract

Persistent pain affects the elderly disproportionally, occurring in 50 % of elderly community-dwelling patients and 80 % of aged care residents. The management of pain in the elderly and frail patient is complicated because of the risks posed by changes in pharmacokinetics and pharmacodynamics, polypharmacy, and drug–disease interactions. Trials evaluating the efficacy of analgesics have often excluded elderly patients and universally excluded frail patients; therefore, the true efficacy and side-effect profiles in these population groups are largely unknown, especially for long-term use. A stepwise approach is recommended to managing pain, commencing with paracetamol and adding on opioids when needed to manage pain. However, because of the short duration of clinical trials, exclusion of frail patients, and minimal inclusion of elderly patients, the decision as to which opioid should be added on to paracetamol is a difficult one. This article reviews the evidence surrounding a newer opioid, tapentadol. Tapentadol acts on both the mu receptors and on neuronal reuptake of noradrenaline, and has no significant analgesically active metabolites, which theoretically presents some advantages, particularly in comparison with tramadol. However, the evidence to support tapentadol is weak and the trials were often methodologically poor and sponsored almost universally by the drug company. Currently, there is insufficient evidence to support the use of tapentadol over other opioids, which have been on the market longer, are less expensive, and have better established safety profiles. As a first-line agent after the failure of paracetamol alone, morphine, oxycodone, fentanyl, or buprenorphine are still the preferred evidence-based choices for add-on opioid therapy for elderly or frail patients.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Pharmacology and Pharmaceutical Sciences
Research Field:Clinical Pharmacology and Therapeutics
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Health Related to Ageing
Author:Veal, FC (Ms Felicity Veal)
Author:Peterson, GM (Professor Gregory Peterson)
ID Code:101375
Year Published:2015
Web of Science® Times Cited:4
Deposited By:Pharmacy
Deposited On:2015-06-22
Last Modified:2017-11-02
Downloads:0

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