Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation

Marzia Lazzari,1 Claudio Marcassa,2 Silvia Natoli,1 Roberta Carpenedo,1 Clarissa Caldarulo,1 Maria B Silvi,1 Mario Dauri1 1Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, 2Cardiology Division, Fondazione Mauger...

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Autores principales:	Lazzari M, Marcassa C, Natoli S, Carpenedo R, Caldarulo C, Silvi MB, Dauri M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	chronic pain elderly naloxone opioid oxycodone Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/955623fbcba445acbf268eb9800d0355
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spelling	oai:doaj.org-article:955623fbcba445acbf268eb9800d03552021-12-02T10:09:20ZSwitching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation1178-1998https://doaj.org/article/955623fbcba445acbf268eb9800d03552016-05-01T00:00:00Zhttps://www.dovepress.com/switching-to-low-dose-oral-prolonged-release-oxycodonenaloxone-from-wh-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Marzia Lazzari,1 Claudio Marcassa,2 Silvia Natoli,1 Roberta Carpenedo,1 Clarissa Caldarulo,1 Maria B Silvi,1 Mario Dauri1 1Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, 2Cardiology Division, Fondazione Maugeri IRCCS Veruno, Novara, Italy Purpose: Chronic pain has a high prevalence in the aging population. Strong opioids also should be considered in older people for the treatment of moderate to severe pain or for pain that impairs functioning and the quality of life. This study aimed to assess the efficacy and safety of the direct switch to low-dose strong opioids (World Health Organization-Step III drugs) in elderly, opioid-naive patients.Patients and methods: This was a single-center, retrospective, observational study in opioid-naive patients aged ≥75 years, with moderate to severe chronic pain (>6-month duration) and constipation, who initiated treatment with prolonged-release oxycodone/naloxone (OXN-PR). Patients were re-evaluated after 15, 30, and 60 days (T60, final observation). Response to treatment was defined as an improvement in pain of ≥30% after 30 days of therapy without worsening of constipation.Results: One-hundred and eighty-six patients (mean ± SD age 80.7±4.7 years; 64.5% women) with severe chronic pain (mean average pain intensity 7.1±1.0 on the 11-point numerical rating scale) and constipation (mean Bowel Function Index 64.1±24.4; 89.2% of patients on laxatives) were initiated treatment with OXN-PR (mean daily dose 11.3±3.5 mg). OXN-PR reduced pain intensity rapidly and was well tolerated; 63.4% of patients responded to treatment with OXN-PR. At T60 (mean daily OXN-PR dose, 21.5±9.7 mg), the pain intensity was reduced by 66.7%. In addition, bowel function improved (mean decrease of Bowel Function Index from baseline to T60, -28.2, P<0.0001) and the use of laxatives decreased. Already after 15 days and throughout treatment, ~70% of patients perceived their status as much/extremely improved. Only 1.6% of patients discontinued treatment due to adverse events.Conclusion: Low-dose OXN-PR in elderly patients naive to opioids proved to be an effective option for the treatment of moderate to severe chronic pain. Large-scale trials are needed to improve clinical guidance in the assessment and treatment of pain in older people. Keywords: chronic pain, elderly, naloxone, opioid, oxycodoneLazzari MMarcassa CNatoli SCarpenedo RCaldarulo CSilvi MBDauri MDove Medical Pressarticlechronic painelderlynaloxoneopioidoxycodoneGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 11, Pp 641-649 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic pain elderly naloxone opioid oxycodone Geriatrics RC952-954.6
spellingShingle	chronic pain elderly naloxone opioid oxycodone Geriatrics RC952-954.6 Lazzari M Marcassa C Natoli S Carpenedo R Caldarulo C Silvi MB Dauri M Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
description	Marzia Lazzari,1 Claudio Marcassa,2 Silvia Natoli,1 Roberta Carpenedo,1 Clarissa Caldarulo,1 Maria B Silvi,1 Mario Dauri1 1Department of Emergency and Critical Care Medicine, Pain Medicine and Anaesthesiology, Tor Vergata Polyclinic, University of Rome, Rome, 2Cardiology Division, Fondazione Maugeri IRCCS Veruno, Novara, Italy Purpose: Chronic pain has a high prevalence in the aging population. Strong opioids also should be considered in older people for the treatment of moderate to severe pain or for pain that impairs functioning and the quality of life. This study aimed to assess the efficacy and safety of the direct switch to low-dose strong opioids (World Health Organization-Step III drugs) in elderly, opioid-naive patients.Patients and methods: This was a single-center, retrospective, observational study in opioid-naive patients aged ≥75 years, with moderate to severe chronic pain (>6-month duration) and constipation, who initiated treatment with prolonged-release oxycodone/naloxone (OXN-PR). Patients were re-evaluated after 15, 30, and 60 days (T60, final observation). Response to treatment was defined as an improvement in pain of ≥30% after 30 days of therapy without worsening of constipation.Results: One-hundred and eighty-six patients (mean ± SD age 80.7±4.7 years; 64.5% women) with severe chronic pain (mean average pain intensity 7.1±1.0 on the 11-point numerical rating scale) and constipation (mean Bowel Function Index 64.1±24.4; 89.2% of patients on laxatives) were initiated treatment with OXN-PR (mean daily dose 11.3±3.5 mg). OXN-PR reduced pain intensity rapidly and was well tolerated; 63.4% of patients responded to treatment with OXN-PR. At T60 (mean daily OXN-PR dose, 21.5±9.7 mg), the pain intensity was reduced by 66.7%. In addition, bowel function improved (mean decrease of Bowel Function Index from baseline to T60, -28.2, P<0.0001) and the use of laxatives decreased. Already after 15 days and throughout treatment, ~70% of patients perceived their status as much/extremely improved. Only 1.6% of patients discontinued treatment due to adverse events.Conclusion: Low-dose OXN-PR in elderly patients naive to opioids proved to be an effective option for the treatment of moderate to severe chronic pain. Large-scale trials are needed to improve clinical guidance in the assessment and treatment of pain in older people. Keywords: chronic pain, elderly, naloxone, opioid, oxycodone
format	article
author	Lazzari M Marcassa C Natoli S Carpenedo R Caldarulo C Silvi MB Dauri M
author_facet	Lazzari M Marcassa C Natoli S Carpenedo R Caldarulo C Silvi MB Dauri M
author_sort	Lazzari M
title	Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
title_short	Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
title_full	Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
title_fullStr	Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
title_full_unstemmed	Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
title_sort	switching to low-dose oral prolonged-release oxycodone/naloxone from who-step i drugs in elderly patients with chronic pain at high risk of early opioid discontinuation
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/955623fbcba445acbf268eb9800d0355
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Switching to low-dose oral prolonged-release oxycodone/naloxone from WHO-Step I drugs in elderly patients with chronic pain at high risk of early opioid discontinuation

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