24 September 2016

Strong opioids suitable for elderly patients – Weight loss reduces joint pain

Elderly patients with chronic musculoskeletal pain often receive inadequate medical treatment. A recent Polish study suggests that this situation does not change until patients are referred to specialised pain clinics. “Prior to referral, the patients receive systemic non-steroidal anti-inflammatory drugs (NSAIDs) all too often and opioids all too rarely. Yet the opioid buprenorphine, for instance, is a highly effective drug for combatting pronounced pain and is just as safe used on elderly patients as on younger ones,” said study author Dr Magdalena Kocot-Kepska from the Collegium Medicum of Jagiellonian University in Krakow (Poland) at a symposium staged in Dubrovnik by the European Pain Federation EFIC. The event is focused on the subject acute and chronic joint pain.
In this study, researchers evaluated data from 165 patients over the age of 80 who were referred to a pain clinic due to chronic complaints. 70 per cent of this group consisted of patients suffering from chronic musculoskeletal pain. Six out of seven patients were women. Prior to admission to the clinics, 71 per cent of the patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs). That was the case even though nearly all of them (95 per cent) suffered from cardiovascular diseases and these analgesics are not indicated in the case of cardiovascular problems. After being admitted to the pain clinic, 35 per cent were given strong opioids, but only a good one in five of these patients displayed slight side-effects. Dr Kocot-Kepska: “A good deal of clarification and clear-cut treatment guidelines are still needed. The concerns about opioids and the excessive use of NSAIDs definitely have to be reconsidered, especially in elderly, most vulnerable patients.”

Weight loss reduces joint pain for osteoarthritic patients
Reduction of body weight reduces the pain level of patients suffering from advanced osteoarthritis. This is shown by a Scottish study that was also presented at the EFIC symposium in Dubrovnik. After losing weight, patients had to take steroidal anti-inflammatory drugs only three times a week instead of four times to combat breakthrough pain, according to the study authors.
In this study 30 people (twelve men, 18 women) were examined to determine how programmed weight reduction would affect their pain level. For 14 weeks, the study participants followed a diet and swam 30 minutes a day under the supervision of a physiotherapist. The participants weighed an average of 95 kilograms initially and the majority of them succeeded in losing about 6.7 per cent of their body weight. At the same time the pain level on the 10-point VAS pain scale fell from 6 to 4 points among the men and from 7 to 6 points among the women.
EFIC has declared 2016 to be the European Year against Joint Pain. The goal of this information campaign is to focus on a health problem from which more than half of the worldwide population over age 50 suffers. Against this background, pain experts attending the symposium in Dubrovnik are discussing the many current trends for understanding and treating pain caused by joint diseases.

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