Table 1.
Summary of Nonrandomized Studies Included in the Analysis of Opiate Prescribing in the Elderly.
| Author | Study Design | N | Mean Age | Opiate Studied | Population Characteristics (Incidence %) | Adverse Effects (Incidence %) |
|---|---|---|---|---|---|---|
| Kennedy et al12 | Observational | 28 | Not reported | Not reported | • Etiology of pain: back/neck pain (47.1), neuropathy
(23.5), rheumatic disease (23.5) • Comorbidities not reported |
GI upset, sedation; incidence not reported |
| Fain et al13 | Observational | 15 432 | Not reported | • Codeine/acetaminophen • Oxycodone • Hydromorphone • Morphine • Methadone • Fentanyl |
• Etiology of pain not reported • Comorbidities: cognitive impairment—borderline intact (20.4), mild (22.2), moderate (25.8), moderately severe (3.7) |
Not reported |
| Fain et al14 | Observational | 17 052 | Not reported | Fentanyl | • Etiology of pain not reported • Comorbidities: cognitive impairment—mild (19.7), moderate (37.1), moderately severe (10.9) |
Not reported |
| Guerriero, 201615 | Observational | 60 | 81 | Oxycodone/naloxone: • Initial dose: 5/2.5 mg po BID • Mean daily dose of oxycodone at 4 weeks = 14.4 mg ± 4.9 mg • Mean daily dose of oxycodone at 52 weeks = 17.4 mg ± 7.7 mg |
Etiology of pain and comorbidities not reported | • Dizziness (46) |
| Lee et al16 | Observational | 451 | 60.52 | Fentanyl: • Mean dose: 15.5 ± 7.72 |
• Etiology of pain: low back pain (27.7), spinal stenosis
(21.7), arthritis (12.64) • Comorbidities not reported |
Not reported |
| Turner et al17 | Observational | 1311 | 64.5 | Specific opiate not reported. Provided morphine daily
equivalents and categorized into frequency of
use: • Minimal/no use: <5 mg • Intermittent/lower dose use: 5-15 mg • Regular/high-dose use: >15 mg |
Etiology of pain and comorbidities not reported | Not reported |
| Petro et al18 | Observational | 53 | 83 | Oxycodone/naloxone: • Initial dose: 5/2.5 mg po BID • Max: 20/10 mg po BID • Mean daily dose of oxycodone: 10.8 ± 4.9 mg |
Etiology of pain: arthritis (47.2), previous fracture (35.8), arthroplasty (11.3), dementia (mean MMSE score = 18.6 ± 3.0) | Severe constipation (9.4), drowsiness (9.4), nausea (5.7), xerostomia (3.8) |
| Dublin et al19 | Observational | 3434 | Not reported | Provided cumulative morphine in past 10
years: • 0-300 mg = 54% • 330-900 mg = 24.2% • 930-8100 mg = 13.8% • >2730 mg = 79.5% |
• Etiology of pain not reported • Comorbidities: cardiovascular disease (66), malignancy (11), depression (10), previous stroke (6) |
Dementia (23) |
| Enthoven et al20 | Observational | 484 | 66 | Not reported | • Etiology of pain: back pain (100) • Comorbidities: alcohol use disorder (50), nicotine use disorder (18) |
Not reported |
| Ringe et al21 | Observational | 630 | 68 | Hydromorphone: • 4 mg/day = 22.3% • 8 mg/day = 40.2% • 16 mg/day = 7.9% |
• Etiology of pain: osteoarthritis, osteoporosis; incidence
not reported • Comorbidities not reported |
Nausea (19.2), constipation (15.7), dizziness (10.8), fatigue (9.2) |
| Uberall et al22 | Observational | 891 | 72.8 | BTDS: • 5 µg/h = 67.1% • 10 µg/h = 27.3% • 20 µg/h = 5.5% |
• Etiology of pain: back pain (40.5), neuropathy (37.3),
arthritis (12.1) • Comorbidities not reported |
Sleep disturbance (18.2), constipation (8.9), dizziness (1.9) |
| Gianni et al23 | Observational | 93 | 79.7 | BTDS: • 11.7 µg/h = 3.5% • 17.5 µg/h = 11.6% • 35 µg/h = 74.4% • 52.5 µg/h = 9.3% • 70 µg/h = 1.2% |
• Etiology of pain: back pain; incidence not
reported • Comorbidities: depression (26.9), cardiovascular disease (incidence not reported) |
Constipation/nausea (15.7), sleepiness (14.2), pruritus (11.2) |
| Gianni et al24 | Observational | 367 | 78 | Not reported | Etiology of pain and comorbidities not reported | Not reported |
| Park and Lavin25 | Observational | 163 | 72.8 | • Acetaminophen/codeine • Oxycodone • Hydromorphone • Morphine • Methadone • Fentanyl |
• Etiology of pain: arthritis (85.3), back/neck pain (75.5),
cancer pain (23.3), osteoporosis
(19.6) • Comorbidities: type II diabetes (36.2), cardiovascular disease (33.7), depression (22.6), previous stroke (8) |
Not reported |
| Unützer et al26 | Observational | 13 | 72.2 | Not reported | • Etiology of pain: arthritis (100) • Comorbidities: depression (100) |
Not reported |
| Unützer et al27 | Observational | 1801 | 71.6 | Not reported | • Etiology of pain: arthritis (55.6) • Comorbidities: depression (100) |
Not reported |
| Won et al28 | Observational | 4426 | Not reported | • Codeine/acetaminophen • Oxycodone • Morphine • Fentanyl |
• Etiology of pain: arthritis (66.3) • Comorbidities: cardiovascular disease (17.8), chronic renal impairment (2.2) |
Depression (25.4), constipation (10.1), falls (7.6) |
| Nassar et al29 | Observational study | 51 | Not reported | • Sublingual buprenorphine | • Etiology of pain: osteoarthritis (62.7), other
(37.4) • Comorbidities: not reported |
Nausea (15.7), vomiting (9.8), confusion (9.8), dizziness (5.9), drowsiness (3.9), depression (2.0), headache (2.0), hallucinations (2.0), diarrhea (2.0), constipation (2.0), sweating (2.0) |
| Pergolizzi et al30 | Retrospective analysis | 1715 | 72.3 | BTDS | • Etiology of pain: arthritis (61), osteoporosis (16.4),
back pain (14.1) • Comorbidities: cardiovascular disease; hypertension (62.9), dyslipidemia (21) |
Nausea (24), dizziness (16.2), constipation (14.5), somnolence (14.1), headache (12.5), falls (3) |
| Lazzari et al31 | Retrospective Analysis | 186 | 80.7 | Oxycodone/naloxone | • Etiology of pain: radiculopathy (37.1), arthritis (18.3), neuropathy (10.8), postherpetic neuralgia (10.2) | Constipation (35.9) |
| Lee et al32 | Retrospective Analysis | 10 | 75.5 | Morphine: • Initial dose: 1-3 mg TID • Maintenance dose: 5-30 mg/day |
• Etiology of pain: back pain (60), neuropathy (60),
radiculopathy (60), arthritis (20) • Comorbidities: Parkinson’s disease (10), previous stroke (10), malignancy (10) |
Constipation (70) |
| Veal et al33 | Retrospective analysis | 19 581 | 77 | • Codeine/acetaminophen • Oxycodone • Morphine • BTDS • Fentanyl |
• Etiology of pain: musculoskeletal pain
(11.7) • Comorbidities: depression (8.3), cognitive impairment (4.1), cardiovascular disease (2.6), Parkinson’s disease (1.0), previous stroke (1.0) |
Not reported |
| Reid et al34 | Retrospective analysis | 133 | 82 | • Codeine/acetaminophen • Oxycodone • Hydromorphone • Morphine • Fentanyl |
• Etiology of pain: back pain (36), arthritis
(35) • Comorbidities: dementia; incidence not reported |
Constipation (22), mental status changes (16), nausea (10) |
| Gallagher et l35 | Retrospective analysis | 47 282 | Not reported | • Codeine/acetaminophen • Buprenorphine |
• Etiology of pain: arthritis (48.7), back pain (35.3),
cancer pain (16.6) • Comorbidities not reported |
Not reported |
| Raffaeli et al36 | Retrospective Analysis | 32 | 72.3 | Morphine (given intrathecally): • Mean initial dose: 0.41 ± 0.28 mg/day • Mean dose at 48 months: 1.03 ± 0.61 mg/day |
• Etiology of pain: neuropathy (65.6), arthritis
(34.3) • Comorbidities not reported |
Drowsiness (21.9), nausea (21.9), urinary retention (18.8), dizziness (12.5), vomiting (12.5), pruritus (12.5) |
| Rigler et al37 | Retrospective analysis | 766 | Not reported | • Oxycodone CR: 10 mg po BID • Morphine SR: 15 mg po BID • Methadone—no dose provided • Fentanyl 25 µg/h |
• Etiology of pain not reported • Comorbidities: cardiovascular disease (28.5), previous stroke (16.4), dementia (11.6), malignancy (10.4), renal impairment (5.0), cirrhosis (1.4) |
Not reported |
| Solomon et al38 | Retrospective analysis | 1861 | Not reported | • Codeine/acetaminophen • Oxycodone • Hydromorphone • Morphine • Methadone |
• Etiology of pain: rheumatoid arthritis (38.6),
osteoarthritis (33.7), back pain
(27.6) • Comorbidities not reported |
Not reported |
| Won et al39 | Retrospective analysis | 813 | 82.5 | Not reported | • Etiology of pain: musculoskeletal
(87.6) • Comorbidities: dementia (18.5), Parkinson’s disease (7.6) |
Falls/fractures (12.3), sleep disturbance (7.7), constipation (7.6), depression (3.9) |
| Kung et al40 | Retrospective analysis | 193 | 74 | Not reported | Etiology of pain and comorbidities not reported | Depression (9.8) |
| Dobscha et al41 | Population-based cohort | 12 924 | Not reported | Not reported | • Etiology of pain: arthritis, back pain, neuropathy, gout,
headache/migraine, fibromyalgia; incidence not
reported • Comorbidities not reported |
Not reported |
| Krebs et al42 | Population-based cohort | 129 | 74.7 | Not reported | • Etiology of pain: knee pain (65.1), arthritis (61.2), hip
pain (59.7) • Comorbidities: frailty (34.9) |
Not reported |
| Kuo et al43 | Population-based cohort | 800 664 | Not reported | Not reported | • Etiology of pain not reported • Comorbidities: cardiovascular disease—HTN (37.9), renal impairment (4.3) |
Not reported |
| Prunuske et al44 | Population-based cohort | 9 325 603 | Not reported | • Codeine/acetaminophen • Oxycodone • Hydromorphone • Morphine • Methadone • Buprenorphine • Fentanyl • Sufentanil |
Not reported | Not reported |
| Koponen et al45 | Population-based cohort | 605 | 81.9 | Not reported | • Etiology of pain: musculoskeletal pain
(52.9) • Comorbidities: frailty (11.4) |
Not reported |
| Saunders, 201046 | Population-based cohort | 2341 | 72.9 | • Codeine/acetaminophen • Oxycodone • Morphine |
• Etiology of pain: back pain (41.6), pain in extremities
(33.6), arthritis (24.9) • Comorbidities: cognitive impairment—borderline intact (20.4), mild (22.2), moderate (25.8), moderately severe (3.6) |
Fracture (13.7) |
Abbreviations: GI, gastrointestinal; po, by mouth; BID, twice a day; MMSE, Mini-Mental State Exam; BTDS, buprenorphine transdermal patch; TID, thrice a day; CR, controlled release; SR, slow release; HTN, hypertension.