Pharmacological treatment of chronic non-malignant pain among elderly persons: an integrative review

Abstract Objective: The objective of the present study was to perform an integrative review of proposed pharmacological treatments for chronic non-malignant pain in elderly patients. Method: An integrative review was carried out. The search of literature included papers about the treatment of chronic pain among the elderly, published from 2007 to 2017 and available in Portuguese or English. Searches were conducted on the LILACS and MEDLINE electronic databases using the key words “chronic pain”, “treatment” and “elderly” combined with the Boolean operator “AND”. To analyse methodological quality, the adapted Critical Appraisal Skill Program (CASP) was used. Results: Of a total of 303 studies found, 32 were included. The articles selected included 20 reviews, five observational studies, five clinical trials, one case series and one retrospective study. A total of 75% of the articles were published in the last five years, of which one was in Portuguese and 31 in English. Conclusion :The results demonstrate a variety of treatments for chronic pain among the elderly population, highlighting the role of opioids which, according to more recent evidence, can be carefully used in treatment. Several drugs, however, have not been specifically tested for the elderly population. A number of factors are relevant in pain management of elderly patients, including comorbidities, polypharmacy and patient functionality. An individualized approach should be applied to elderly patients to improve outcomes and reduce side effects.

摘要 研究目的：本研究旨在针对老年患者慢性非癌性疼痛（chronic non-malignant pain）的拟用药物治疗方案开展整合性综述。研究方法：本研究采用整合性综述研究设计。文献检索范围涵盖2007年至2017年发表的葡萄牙语或英语老年慢性疼痛治疗相关研究，检索数据库为拉丁美洲与加勒比卫生科学文献数据库（LILACS）及医学文献联机检索系统（MEDLINE），检索关键词设置为“慢性疼痛（chronic pain）”“治疗（treatment）”与“老年人群（elderly）”，并通过布尔逻辑运算符“AND”组合检索。本研究采用经修订的关键评价技能计划（Critical Appraisal Skill Program, CASP）对纳入文献的方法学质量进行分析评价。研究结果：本次检索共获取303篇相关文献，最终纳入32篇。纳入的研究类型包括20篇综述、5篇观察性研究、5篇临床试验、1篇病例系列研究及1篇回顾性研究。其中75%的文献发表于近五年，语种涵盖1篇葡萄牙语文献及31篇英语文献。研究结论：研究结果显示，老年人群慢性疼痛的临床治疗方案品类丰富，其中阿片类药物（opioids）的应用价值尤为突出；最新研究证据表明，阿片类药物可在严格管控下用于老年慢性疼痛的治疗。然而，尚有部分药物未针对老年人群开展专项临床试验。老年患者的疼痛管理需综合考量多项相关因素，包括合并症（comorbidities）、多重用药（polypharmacy）及患者功能状态（patient functionality）。临床应针对老年患者实施个体化干预方案，以优化治疗结局并降低不良反应（side effects）发生率。