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• W2001193057 abstract "Kenneth Boockvar, MD, MS In recent decades, clinicians have increasingly recognized the importance of symptom control as a health priority on par with treating and controlling disease. Studies indicate that the highest priorities of patients with serious conditions such as cancer or end-stage kidney disease are to have their pain and other symptoms relieved, to have their quality of life optimized, to avoid being a burden to their family, and to maintain a sense of control.1Singer P.A. Martin D.K. Kelner M. Quality end-of-life care: patients’ perspectives.JAMA. 1999; 281: 163-168Crossref PubMed Scopus (1034) Google Scholar, 2Steinhauser K.E. Christakis N.A. Clipp E.C. et al.Factors considered important at the end of life by patients, family, physicians, and other care providers.JAMA. 2000; 284: 2476-2482Crossref PubMed Scopus (1841) Google Scholar Symptom management is particularly important for older adults living with multiple chronic conditions for whom optimizing quality of life is a primary goal. Pain is a chief symptom reported by older adults3Jakobsson U. Klevsgard R. Westergren A. Hallberg I.R. Old people in pain: a comparative study.J Pain Symptom Manage. 2003; 26: 625-636Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar and a common cause of emergency department visits.4Platts-Mills T.F. Esserman D.A. Brown D.L. et al.Older US emergency department patients are less likely to receive pain medication than younger patients: results from a national survey.Ann Emerg Med. 2012; 60: 199-206Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar Pain is associated with serious complications such as disability,5Andrews J.S. Cenzer I.S. Yelin E. Covinsky K.E. Pain as a risk factor for disability or death.J Am Geriatr Soc. 2013; 61: 583-589Crossref PubMed Scopus (50) Google Scholar, 6Reyes-Gibby C.C. Aday L. Cleeland C. Impact of pain on self-rated health in the community-dwelling older adults.Pain. 2002; 95: 75-82Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar depression,3Jakobsson U. Klevsgard R. Westergren A. Hallberg I.R. Old people in pain: a comparative study.J Pain Symptom Manage. 2003; 26: 625-636Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar, 6Reyes-Gibby C.C. Aday L. Cleeland C. Impact of pain on self-rated health in the community-dwelling older adults.Pain. 2002; 95: 75-82Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar falls,7Leveille S.G. Jones R.N. Kiely D.K. et al.Chronic musculoskeletal pain and the occurrence of falls in an older population.JAMA. 2009; 302: 2214-2221Crossref PubMed Scopus (343) Google Scholar and death5Andrews J.S. Cenzer I.S. Yelin E. Covinsky K.E. Pain as a risk factor for disability or death.J Am Geriatr Soc. 2013; 61: 583-589Crossref PubMed Scopus (50) Google Scholar in older adults. Research on the epidemiology, risk factors, complications, screening, and management of pain caused by conditions that commonly occur in older adults has grown greatly in recent years. This includes research on pharmacologic (including biologic)8Akinbosoye O. Matlin O.S. Mostovoy L. et al.Conventional and biologic rheumatoid arthritis therapies: utilization and cost trends.Am J Pharmacy Benefits. 2012; 4: 295-298Google Scholar, 9Baxter R. Bramlett K. Onel E. Daniels S. Impact of local administration of liposome bupivacaine for postsurgical analgesia on wound healing: a review of data from ten prospective, controlled clinical studies.Clin Ther. 2013; 35 (e5): 312-320Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar, 10Richards P. Gimbel J.S. Minkowitz H.S. et al.Comparison of the efficacy and safety of dual-opioid treatment with morphine plus oxycodone versus oxycodone/acetaminophen for moderate to severe acute pain after total knee arthroplasty.Clin Ther. 2013; 35: 498-511Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 11Shin K. Kim J.W. Moon K.W. et al.The efficacy of diacerein in hand osteoarthritis: a double-blind, randomized, placebo-controlled study.Clin Ther. 2013; 35: 431-439Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 12Vinik A. Emir B. Cheung R. Whalen E. Relationship between pain relief and improvements in patient function/quality of life in patients with painful diabetic peripheral neuropathy or postherpetic neuralgia treated with pregabalin.Clin Ther. 2013; 35: 612-623Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar and nonpharmacologic13Stewart C. Leveille S.G. Shmerling R.H. et al.Management of persistent pain in older adults: the MOBILIZE Boston Study.J Am Geriatr Soc. 2012; 60: 2081-2086PubMed Google Scholar therapeutics, re-examination of injection procedures in common use,14Pinto R.Z. Maher C.G. Ferreira M.L. et al.Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis.Ann Intern Med. 2012; 157: 865-877Crossref PubMed Scopus (202) Google Scholar cost analysis studies,15Kuan R. Holt R.J. Johnson K.E. et al.Budget impact modeling for a single-tablet formulation of ibuprofen and famotidine for prevention of upper gastrointestinal ulcers in patients with osteoarthritis and/or rheumatoid arthritis.Clin Ther. 2013; 35: 321-332Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 16Merchant S. Noe L.L. Howe A. et al.Budget impact analysis of tapentadol extended release for the treatment of moderate to severe chronic noncancer pain.Clin Ther. 2013; 35: 659-672Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar and original studies on usage trends and the efficacy and safety of nonopioid15Kuan R. Holt R.J. Johnson K.E. et al.Budget impact modeling for a single-tablet formulation of ibuprofen and famotidine for prevention of upper gastrointestinal ulcers in patients with osteoarthritis and/or rheumatoid arthritis.Clin Ther. 2013; 35: 321-332Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 17O’Neil C.K. Hanlon J.T. Marcum Z.A. Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics.Am J Geriatr Pharmacother. 2012; 10: 331-342Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar and opioid analgesics.17O’Neil C.K. Hanlon J.T. Marcum Z.A. Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics.Am J Geriatr Pharmacother. 2012; 10: 331-342Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar, 18Rolita L. Spegman A. Tang X. Cronstein B.N. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults.J Am Geriatr Soc. 2013; 61: 335-340Crossref PubMed Scopus (96) Google Scholar, 19Von Korff M. Kolodny A. Deyo R.A. Chou R. Long-term opioid therapy reconsidered.Ann Intern Med. 2011; 155: 325-328Crossref PubMed Scopus (173) Google Scholar, 20Painter J.T. Crofford L.J. Talbert J. Geographic variation of chronic opioid use in fibromyalgia.Clin Ther. 2013; 35: 303-311Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Despite the key role that pharmacologic agents, especially opioid analgesics, play in the treatment of severe pain, adverse effects (including accidental overdose) make them risky or intolerable to many older adults and help drive current efforts to improve pain care in this population. In this issue of Clinical Therapeutics, we report on contemporary issues in pain care for older adults, including articles on pain screening, nonpharmacologic management, pharmacologic management, and novel procedures for pain, with state-of-the art original investigations, reviews, and commentaries. First, Tracy and Morrison21Tracy B. Morrison R.S. Pain management in older adults.Clin Ther. 2013; 35: 1659-1668Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar review the literature on pain management in older adults from 2000 to the present and discuss principles of pain management in this population in the context of pathophysiologic changes associated with aging. Second, Atkinson et al22Atkinson T.J. Fudin J. Pandula A. Mirza M. Medication pain management in the elderly: unique and underutilized analgesic treatment options.Clin Ther. 2013; 35: 1669-1689Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar review selected pharmacologic agents for pain that might be particularly useful in older adults based on the ability of these agents to achieve therapeutic tissue levels, their toxicity profiles, and their interactions with other medications. Two articles follow on the important subject of complementary and alternative medicine (CAM) modalities for pain. Yang et al23Yang S. Dubé C.E. Eaton C.B. et al.Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis.Clin Ther. 2013; 35: 1690-1702Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar report on patterns of CAM use by older adults with osteoarthritis. They found that over a 4-year study period, one third of older adults used at least 1 CAM modality, but few were persistent users of any single CAM modality, with the exception of glucosamine and chondroitin. This lack of persistent use may reflect not only a lack of efficacy of these agents but also characteristics of the population that uses CAM modalities. Weiner et al24Weiner D.K. Moore C.G. Morone N.E. et al.Efficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: a randomized controlled clinical trial.Clin Ther. 2013; 35: 1703-1720Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar report the results of the first efficacy trial of a new CAM modality related to acupuncture: periosteal stimulation therapy, a technique that delivers high-frequency electrical stimulation to the periosteum by using acupuncture needles. In a randomized controlled trial in adults aged >50 years with advanced osteoarthritis, 6 months of periosteal stimulation therapy was well tolerated and reduced pain compared with controls. Bednar et al25Bednar T. Heyde C.E. Bednar G. et al.Kyphoplasty for vertebral augmentation in the elderly with osteoporotic vertebral compression fractures: scenarios and review of recent studies.Clin Ther. 2013; 35: 1721-1727Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar review controversies over the use of vertebroplasty and kyphoplasty for vertebral compression fractures in older adults in the context of 2 patient case reports. Although these procedures are reimbursed by insurance (including Medicare) for carefully selected patients, evidence demonstrating their efficacy in reducing pain and improving functional outcomes compared with sham control procedures is lacking. Finally, Morone and Weiner26Morone N.E. Weiner D.K. Pain as the 5th vital sign: exposing the vital need for pain education.Clin Ther. 2013; 35: 1728-1732Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar provide a commentary on the pitfalls of widespread incorporation of pain scores into vital sign reports without associated training and education for providers on how to respond to those reports. The articles in this special issue follow other articles on the topic of pain management appearing in this journal in 2013.9Baxter R. Bramlett K. Onel E. Daniels S. Impact of local administration of liposome bupivacaine for postsurgical analgesia on wound healing: a review of data from ten prospective, controlled clinical studies.Clin Ther. 2013; 35 (e5): 312-320Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar, 10Richards P. Gimbel J.S. Minkowitz H.S. et al.Comparison of the efficacy and safety of dual-opioid treatment with morphine plus oxycodone versus oxycodone/acetaminophen for moderate to severe acute pain after total knee arthroplasty.Clin Ther. 2013; 35: 498-511Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 11Shin K. Kim J.W. Moon K.W. et al.The efficacy of diacerein in hand osteoarthritis: a double-blind, randomized, placebo-controlled study.Clin Ther. 2013; 35: 431-439Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 12Vinik A. Emir B. Cheung R. Whalen E. Relationship between pain relief and improvements in patient function/quality of life in patients with painful diabetic peripheral neuropathy or postherpetic neuralgia treated with pregabalin.Clin Ther. 2013; 35: 612-623Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar, 15Kuan R. Holt R.J. Johnson K.E. et al.Budget impact modeling for a single-tablet formulation of ibuprofen and famotidine for prevention of upper gastrointestinal ulcers in patients with osteoarthritis and/or rheumatoid arthritis.Clin Ther. 2013; 35: 321-332Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 16Merchant S. Noe L.L. Howe A. et al.Budget impact analysis of tapentadol extended release for the treatment of moderate to severe chronic noncancer pain.Clin Ther. 2013; 35: 659-672Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 20Painter J.T. Crofford L.J. Talbert J. Geographic variation of chronic opioid use in fibromyalgia.Clin Ther. 2013; 35: 303-311Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Together, they fit research agendas on acute and chronic pain planned or released by the National Institutes of Health,27Pain Research Forum. US National Institutes of Health releases first federal plan to advance research on overlapping pain conditions. http://www.painresearchforum.org/forums/discussion/25398-us-national-institutes-health-releases-first-federal-plan-advance-research. Accessed September 24, 2013.Google Scholar leading industry and academic neuroscientists,28Global Technology Community. Pain research and therapeutics. http://www.gtcbio.com/conference/pain-research-and-therapeutics-agenda. Accessed September 24, 2013.Google Scholar and health services and patient safety researchers.29Becker W.C. Fraenkel L. Kerns R.D. Fiellin D.A. A research agenda for enhancing appropriate opioid prescribing in primary care.J Gen Intern Med. 2013; 28: 1364-1367Crossref PubMed Scopus (13) Google Scholar Research is needed to advance our understanding of the underlying biology of pain, to discover more efficacious pain therapies that have fewer adverse effects, and to develop better models of health care delivery that provide appropriate treatments to the right patients at the right time. Finally, for clinicians looking to refer older adults with severe, complex conditions for pain management, a growing cadre of geriatrics and palliative medicine specialists promote a therapeutic approach that prioritizes symptom relief and quality of life in this patient population." @default.
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• W2001193057 title "Pain Therapeutics in Older Adults" @default.
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