Kaye Alan D, Baluch Amir, Scott Jared T
Ochsner J. 2010 Fall;10(3):179-87.
The elderly population comprises the fastest growing segment of the world's population. As patients age, the incidence and prevalence of certain pain syndromes increase. Pain may be underreported as some elderly patients incorrectly believe that pain is a normal process of aging. A comprehensive pain assessment includes a thorough medical history and physical examination, review of systems and pertinent laboratory results, imaging studies, and diagnostic tests. Pain physicians should have a broad range of understanding of the pharmacologic and physiological changes that occur in the geriatric population. The present review on pain management in the elderly focuses on relevant information for the pain clinician. Included are appropriate pain assessment, physical examination, pathophysiologic changes in the elderly, pharmacokinetic and pharmacodynamic changes, and present pain management modalities. Elderly patients present with increased fat mass, decreased muscle mass, and decreased body water, all of which have important ramifications on drug distribution. Hepatic phase I reactions involving oxidation, hydrolysis, and reduction appear to be more altered by age than phase II conjugation such as acetylation, glucuronidation, sulfation, and glycine conjugation. There is a predictable age-related decline in cytochrome P-450 function and, combined with the polypharmacy that much of the elderly population experiences, this may lead to a toxic reaction of medications. One of the newer opiates, oxymorphone, has recently been studied as it is metabolized in a non-cytochrome P-450 pathway and therefore bypasses many of the drug-drug interactions common to the elderly. A multidisciplinary approach is recommended to investigate all possible options for optimal management, including pharmacotherapy, interventional procedures, physical rehabilitation, and psychological support.
老年人口是世界人口中增长最快的部分。随着患者年龄的增长，某些疼痛综合征的发病率和患病率会增加。由于一些老年患者错误地认为疼痛是衰老的正常过程，疼痛可能未得到充分报告。全面的疼痛评估包括详尽的病史和体格检查、系统回顾以及相关实验室检查结果、影像学检查和诊断测试。疼痛科医生应广泛了解老年人群中发生的药理和生理变化。本次关于老年人疼痛管理的综述聚焦于对疼痛临床医生有用的信息。内容包括适当的疼痛评估、体格检查、老年人的病理生理变化、药代动力学和药效学变化以及当前的疼痛管理模式。老年患者的体脂增加、肌肉量减少、身体水分减少，所有这些都会对药物分布产生重要影响。与氧化、水解和还原有关的肝脏I期反应似乎比乙酰化、葡萄糖醛酸化、硫酸化和甘氨酸结合等II期结合反应更容易受到年龄的影响。细胞色素P - 450功能会随着年龄增长而出现可预测的下降，再加上许多老年患者同时服用多种药物，这可能会导致药物产生毒性反应。新型阿片类药物之一羟吗啡酮最近得到了研究，因为它通过非细胞色素P - 450途径代谢，因此避开了许多老年患者中常见的药物相互作用。建议采用多学科方法来研究所有可能的最佳管理方案，包括药物治疗、介入手术、物理康复和心理支持。
