Pickering Gisèle
Université Clermont 1, UFR de médecine, EA 3848, Pharmacologie médicale, Clermont-Ferrand.
Psychol Neuropsychiatr Vieil. 2006 Jun;4(2):95-102.
Pain prevalence is high in older persons. Aging is associated with modification in pain perception and with noticeable changes in the pharmacology of analgesics. Therefore, after an accurate identification of the presence and type of pain, treatment must take into account various factors including comorbidities and polymedication that are landmarks of aging. Among pharmacokinetic changes with age, one must especially focus on renal elimination of analgesics and their metabolites, and on the increased risk of drug interactions and side-effects. Pharmacodynamic changes with age stress the vulnerability of elderly persons to drugs and require a lower dosage and a slower titration. Analgesics, co-analgesics and their contra-indications do not differ from those in younger patients, and their side-effects, well documented, can often be anticipated. It is therefore necessary when treating pain in the elderly to have a double systematic reflex of pain identification and of drug interactions, in order to improve pain treatment and quality of life, and to optimize the analgesic benefit/risk ratio.
疼痛在老年人中普遍存在。衰老与疼痛感知的改变以及镇痛药药理学的显著变化有关。因此，在准确识别疼痛的存在和类型后，治疗必须考虑各种因素，包括作为衰老标志的合并症和多种药物治疗。在随年龄增长的药代动力学变化中，必须特别关注镇痛药及其代谢产物的肾脏清除，以及药物相互作用和副作用风险的增加。随年龄增长的药效学变化强调了老年人对药物的易感性，需要较低的剂量和较慢的滴定速度。镇痛药、辅助镇痛药及其禁忌证与年轻患者并无不同，其副作用有充分记录，通常可以预见。因此，在治疗老年人疼痛时，有必要对疼痛识别和药物相互作用进行双重系统反应，以改善疼痛治疗和生活质量，并优化镇痛效益/风险比。
