Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200014
Brazilian Journal of Pain
Review Article

The use of opioids in the treatment of oncologic pain in the elderly

O uso de opioides no tratamento da dor oncológica em idosos

Ledismar José da Silva; Diego Machado Mendanha; Patrícia Pádua Gomes

http://dx.doi.org/10.5935/2595-0118.20200014 BrJP, vol.3, n1, p.63-72, 2020
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Abstract

BACKGROUND AND OBJECTIVES: The use of opioids in cancer is already widespread and proven by several well-controlled clinical trials. However, the elderly with cancer pain are=un-dertreated due to the lack of knowledge in the management of these patients, the underestimation of pain, as well as the fear of complications arising in this age group. Therefore, the scientific community contributes to giving inputs to create possible clinical and health guidelines. The present study aimed to perform a systematic literature review of opioid treatments proposed for cancer-related pain in elderly patients.

CONTENTS: The search on the literature included papers addressing cancer pain treatment with opioids among the elderly, published from 2008 to 2018, and available in Portuguese or English. Searches were conducted on Medical Literature, Analysis, and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) electronic databases using the keywords “cancer pain”, “opioids”, and “elderly” in both languages, combined with the Boolean operator “AND”. To analyze the quality of the method, the adapted Critical Appraisal Skills Programme was used. Of a total of 411 studies found, 32 were included. About 75% of the selected articles were published in the last five years.

CONCLUSION: The results showed that opioids remain the pillar to treat cancer-related pain in the elderly. They can be used for better management of pain, but with caution due to the possible adverse effects. In addition, pain management in the elderly requires a multifactorial analysis, including comorbidities, polypharmacy, and patient functionality. Therefore, an individualized approach in the elderly patient is required in order to enhance results, reduce side effects, and improve quality of life.

Keywords

Cancer pain, Elderly, Opioids

Resumo

JUSTIFICATIVA E OBJETIVOS: O uso de opioides em dor oncológica já é amplamente difundido e comprovado por diversos ensaios clínicos bem controlados. Entretanto, os idosos com dor oncológica são subtratados pela falta de conhecimento no manejo, a não valorização álgica nesses pacientes, bem como o receio das complicações advindas nesse grupo etário. Portanto, contribui a comunidade científica, dando substrato para a elaboração de possíveis diretrizes clínicas e de saúde. Este estudo teve como objetivo realizar uma revisão sistemática da literatura sobre o tratamento farmacológico com opioides proposto para dor oncológica em pacientes idosos.

CONTEÚDO: A busca na literatura incluiu artigos sobre o uso de opioides para o tratamento da dor oncológica em idosos, publicados entre 2008 e 2018, disponíveis em português ou inglês. Foram conduzidas buscas nas bases eletrônicas de dados Medical Literature, Analysis, and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS) utilizando os descritores “dor oncológica”,“opioides” e “idoso” em ambas as línguas, combinados com o operador booleano “AND”. Para a análise da qualidade metodológica, foi utilizado o Critical Appraisal Skills Programme adaptado. Do total de 411 estudos resultantes, foram incluídos 32. Cerca de 75% dos artigos selecionados foram publicados nos últimos cinco anos.

CONCLUSÃO: Os resultados demonstraram que os opioides continuam sendo o pilar no tratamento da dor oncológica em idosos. Podem ser usados para o melhor gerenciamento da dor, mas com cautela por causa dos possíveis efeitos adversos. Além disso, o manejo da dor em idosos requer uma análise multifatorial incluindo as comorbidades, a polifarmácia e a funcionalidade do paciente. Portanto, é necessário tratar de modo individualizado o paciente idoso com o intuito de maximizar os resultados, diminuir os efeitos adversos e melhorar a qualidade de vida.

Palavras-chave

Dor oncológica, Idosos, Opioides

References

World population prospects: the 2017 revision, key findings and advance tables. Working Paper No. ESA/P/WP/248. 2017.

Figueiredo AH. Brasil: uma visão geográfica e ambiental no início do século XXI. 2016.

Miranda GM, Mendes AC, Silva AL. O envelhecimento populacional brasileiro: desafios e consequências sociais atuais e futuras. Rev Bras Geriatr Gerontol. 2016;19(3):507-19.

Estapé T. Cancer in the elderly: challenges and barriers. Asia Pac J Oncol Nurs. 2018;5(1):40-2.

Rangel O, Telles C. Tratamento da dor oncológica em cuidados paliativos. Rev Hosp Universit Pedro Ernesto. 2012;11:32-7.

Reyes-Gibby CC, Anderson KO, Todd KH. Risk for opioid misuse among emergency department cancer patients. Acad Emerg Med. 2016;23(2):151-8.

Yen TY, Chiou JF, Chiang WY, Su WH, Huang MY, Hu MH. Proportional dose of rapid-onset opioid in breakthrough cancer pain management: An open-label, multicenter study. Medicine. 2018;97(30).

Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin. 2011;61(3):157-82.

Cancer pain relief. 1986.

Coluzzi F, Taylor Jr R, Pergolizzi Jr JV, Mattia C, Raffa RB. [Good clinical practice guide for opioids in pain management: the three Ts - titration (trial), tweaking (tailoring), transition (tapering)]. Rev Bras Anestesiol. 2016;66(3):310-7.

Wilson KG, Chochinov HM, Allard P, Chary S, Gagnon PR, Macmillan K. Prevalence and correlates of pain in the Canadian National Palliative Care Survey. Pain Res Manag. 2009;14(5):365-70.

Galicia-Castillo M. Opioids for persistent pain in older adults. Cleve Clin J Med. 2016;83(6):443-51.

Passik SD. Issues in long-term opioid therapy: unmet needs, risks, and solutions. Mayo Clin Proc. 2009;84(7):593-601.

Hennemann-Krause L. Aspectos práticos da prescrição de analgésicos na dor do câncer. Rev Hosp Universit Pedro Ernesto. 2012;11:38-49.

Madadi P, Hildebrandt D, Lauwers AE, Koren G. Characteristics of opioid-users whose death was related to opioid-toxicity: a population-based study in Ontario, Canada. PLoS One. 2013;8(4).

Srisawang P, Harun-Or-Rashid M, Hirosawa T, Sakamoto J. Knowledge, attitudes and barriers of physicians, policy makers/regulators regarding use of opioids for cancer pain management in Thailand. Nagoya J Med Sci. 2013;75:201-12.

Zeppetella G. Fentanyl sublingual spray for breakthrough pain in cancer patients. Pain Ther. 2013;2(1):1-9.

Kraychete DC, Siqueira JT, Garcia JB. Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly. Rev Dor. 2014;15(Suppl 1):S65-9.

Nunes BC, Garcia JB, Sakata RK. [Morphine as first medication for treatment of cancer pain]. Braz J Anestesiol. 2014;64(4):236-40.

Rocha LS, Beuter M, Neves ET, Leite MT, Brondani MC, Perlini NM. Self-care of elderly cancer patients undergoing outpatient treatment. Texto Contexto Enferm. 2014;23(1):29-37.

Kim YC, Ahn JS, Calimag MM, Chao TC, Ho KY, Tho LM. Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries. Cancer Med. 2015;4(8):1196-204.

Reticena KO, Beuter M, Sales CA. Vivências de idosos com a dor oncológica: abordagem compreensiva existencial. Rev Esc Enferm USP. 2015;49(3):419-25.

Cella IF, Trindade LCT, Sanvido LV, Skare TL. Prevalence of opiophobia in cancer pain treatment. Rev Dor. 2016;17(4):245-7.

Lin CP, Hsu CH, Fu WM, Chen HM, Lee YH, Lai MS. Key opioid prescription concerns in cancer patients: a nationwide study. Acta Anaesthesiol Taiwan. 2016;54(2):51-6.

Oosten AW, Abrantes JA, Jonsson S, De Bruijn P, Kuip EJM, Falcão A. Treatment with subcutaneous and transdermal fentanyl: Results from a population pharmacokinetic study in cancer patients. Eur J Clin Pharmacol. 2016;72(4):459-67.

Reddy A, Tayjasanant S, Haider A, Heung Y, Wu J, Liu D. The opioid rotation ratio of strong opioids to transdermal fentanyl in cancer patients. Cancer. 2016;122(1):149-56.

Barbera L, Sutradhar R, Chu A, Seow H, Howell D, Earle CC. Opioid prescribing among cancer and non-cancer patients: Time trend analysis in the elderly using administrative data. J Pain Symptom Manage. 2017;54(4):484-92.e1.

Bennett M, Paice JA, Wallace M. Pain and opioids in cancer care: benefits, risks, and alternatives. Am Soc Clin Oncol Educ Book. 2017;37:705-13.

Haider A, Zhukovsky DS, Meng YC, Baidoo J, Tanco KC, Stewart HA. Opioid prescription trends among patients with cancer referred to outpatient palliative care over a 6-year period. J Oncol Pract. 2017;13(12):e972-81.

Kuip EJ, Zandvliet ML, Koolen SL, Mathijssen RH, van der Rijt CC. A review of factors explaining variability in fentanyl pharmacokinetics; focus on implications for cancer patients. Br J Clin Pharmacol. 2017;83:294-313.

Lee KH, Kim TW, Kang JH, Kim JS, Ahn JS, Kim SY. Efficacy and safety of controlled-release oxycodone/naloxone versus controlled-release oxycodone in Korean patients with cancer-related pain: a randomized controlled trial. Clin J Cancer. 2017;36(1):74.

Nosek K, Leppert W, Nosek H, Wordliczek J, Onichimowski D. A comparison of oral controlled-release morphine and oxycodone with transdermal formulations of buprenorphine and fentanyl in the treatment of severe pain in cancer patients. Drug Des Devel Ther. 2017;11:2409-19.

Schmidt-Hansen M, Bennett MI, Arnold S, Bromham N, Hilgart JS. Oxycodone for cancer-related pain. Cochrane Database Syst Rev. 2017;8:CD003870.

Guitart J, Vargas MI, De Sanctis V, Folch J, Salazar R, Fuentes J. Efficacy and safety of sublingual fentanyl tablets in breakthrough cancer pain management according to cancer stage and background opioid medication. Drugs R D. 2018;18(2):119-28.

Masel EK, Landthaler R, Gneist M, Watzke HH. Fentanyl buccal tablet for breakthrough cancer pain in clinical practice: results of the non-interventional prospective study ErkentNIS. Support Care Cancer. 2018;26(2):491-7.

Peng Z, Zhang Y, Guo J, Guo X, Feng Z. Patient-controlled intravenous analgesia for advanced cancer patients with pain: A retrospective series study. Pain Res Manag. 2018.

Yamada M, Matsumura C, Jimaru Y, Ueno R, Takahashi K, Yano Y. Effect of continuous pharmacist interventions on pain control and side effect management in outpatients with cancer receiving opioid treatments. Biol Pharm Bull. 2018;41(6):858-63.

Dor: o quinto sinal vital - Abordagem prática no idoso. 2018.

Kim HJ, Kim YS, Park SH. Opioid rotation versus combination for cancer patients with chronic uncontrolled pain: a randomized study. BMC Palliat Care. 2015;14(1):41.

Ribeiro S, Schmidt AP, Schmidt SR. [Opioids for treatment non-malignant chronic pain: the role of methadone]. Rev Bras Anestesiol. 2002;52(5):644-51.

Nguyen LMT, Rhondali W, De La Cruz M, Hui D, Palmer L, Kang DH. Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer. J Pain Symptom Manage. 2013;45(3):506-16.

Submitted date:
06/23/2019

Accepted date:
12/09/2019

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