Schuler M, Grießinger N
Klinik für Geriatrie und Palliativmedizin, Diakonissenkrankenhaus, Speyerer Str. 91-93, 68163, Mannheim, Deutschland.
Schmerzambulanz, Anästhesiologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
Schmerz. 2015 Aug;29(4):380-401. doi: 10.1007/s00482-015-0029-x.
Opioids are increasingly used in the elderly. Side effects differ compared to other analgesics.
In this review article, special aspects about using opioids for noncancer pain in older people and in geriatric patients are identified.
So far randomized controlled trials for the indication of and comparison between various opioids have been performed in middle-aged patients and not exclusively in geriatric patients or elderly (> 75 years). Furthermore, the evidence for multimorbid elderly patients with respect to side effects is also very poor.
The indication for opioid therapy should be narrow. The patient and their caregivers must be provided patient information regarding opioid therapy. The principle "start low, go slow" is highly recommended. To reduce the risk of falls, longer acting opioids should be used and short acting opioids should be avoided. Everyday relevant negative effects on cognition are possible in opioid use and have to be observed. As recommended in the recently published German guideline for long-term use of opioids in noncancer pain a critical check after 3 months and in case of dosing over 120 mg morphine equivalents is advisable, especially for older patients. Liver and kidney function and drug interactions have to be taken into consideration like in every age group.
阿片类药物在老年人中的使用越来越多。与其他镇痛药相比，其副作用有所不同。
在这篇综述文章中，确定了在老年人和老年患者中使用阿片类药物治疗非癌性疼痛的特殊方面。
到目前为止，各种阿片类药物的适应症及相互比较的随机对照试验是在中年患者中进行的，并非专门针对老年患者或高龄（>75岁）患者。此外，关于多病共存老年患者副作用的证据也非常少。
阿片类药物治疗的适应症应严格。必须向患者及其护理人员提供有关阿片类药物治疗的患者信息。强烈推荐“从小剂量开始，缓慢增加剂量”的原则。为降低跌倒风险，应使用长效阿片类药物，避免使用短效阿片类药物。使用阿片类药物时可能会出现与日常相关的认知负面影响，必须加以观察。正如最近发布的德国非癌性疼痛长期使用阿片类药物指南所建议的，3个月后以及吗啡当量剂量超过120mg时进行一次关键检查是明智的，尤其是对于老年患者。与每个年龄组一样，必须考虑肝肾功能和药物相互作用。
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