Is Buprenorphine an analgesic alternative in older people?.In older people with opioid use disorder as a result of chronic pain management, buprenorphine may be a safer alternative to pain management, new research notes. [ 1 ]
Results of a literature review by researchers at the University of Kansas Medical Center , Kansas City, United States, indicate that buprenorphine, an opioid used to treat opioid use disorder and also chronic and acute pain, may be a better option for treating pain in patients with chronic pain, over the age of 65, who have become addicted to opioids.
The results of the analysis show that data are generally available to support the use of buprenorphine in elderly patients. It is well tolerated, has fewer side effects and improves pain control, says study researcher Dr. Dheepthy Arakonam Ravishankar.
Some of these patients had poor pain control and low quality of life, which improved after starting buprenorphine treatment.
The findings were presented at the 30th Annual Congress of the American Academy of Addiction Psychiatry .
A growing problem
Addiction is a growing problem among older people. In the United States, the number of Americans age 50 and older with a substance use disorder will double, from 2.8 million in 2002-2006 to 5.7 million in 2020.
Many older people get opioid use disorder after years of using prescribed opioids to treat chronic pain. However, with aging, changes in drug metabolism arise, increasing the risk of adverse effects, including organ damage.
“We have observed that over the years our population of patients with opioid use disorder has changed; Before, these were young adults who used heroin for the most part, and now they are elderly patients who have been receiving prescribed opioids for chronic pain, but who are referred to the addiction clinic because they acquired opioid use disorder, “he said. Principal Investigator, Dr. Roopa Sethi.
This change in the population served in the clinic prompted researchers to perform a literature review to determine the optimal treatment in this patient population.
In total, they found nine studies on opioid use disorder in elderly patients, of which four focused specifically on the use of buprenorphine for chronic pain in these people.
The results demonstrated that buprenorphine was effective as a treatment for chronic pain in patients 65 to 84 years of age. The response was better among those 80 years of age or older than those who were under 80 years of age.
Buprenorphine also decreased sleep disturbances caused by pain and improved quality of life.
The drug was well tolerated. The reported side effects were constipation, nausea, dizziness, vomiting, and respiratory depression in older and frail patients.
A critical problem
Dr. Carla Marienfeld, addiction psychiatrist and full professor at the University of California , California, United States, noted that the study clarifies a “fundamental question.”
He added that in his own practice he has observed a “huge change” in the number of older patients with chronic pain who have referred him and who have difficulties with opioid use disorder.
These findings are “very useful” for psychiatrists, he added. Even when these specialists do not treat pain, it is helpful for them to understand that a drug such as buprenorphine, which is used to treat opioid use disorder, may be useful for other concomitant disorders such as pain.
Dr. Marienfeld believes that psychiatrists, including those specializing in addictions, may not realize that buprenorphine has fewer side effects, less impact on the immune response, and generally requires less dose adjustment than other opioids.
Often you should advise surgeons, dentists, and other health professionals who are the primary caregivers of pain, but who may not be aware of the subtleties of such treatment.
These findings help clinicians make decisions about what we could do to help this new population of elderly people who are now beginning to be seen in addiction clinics.