Tratamiento del dolor en el anciano: opioides y adyuvantes

espanolSe dispone de pocos estudios sobre el uso de opioides en ancianos. En pacientes seleccionados, los opioides pueden proporcionar una adecuada analgesia en el marco de un abordaje integral. Se ha revisado la utilizacion de opioides fuertes en ancianos con dolor oncologico o no oncologico. Se ha demostrado eficacia en dolor musculo-esqueletico a corto plazo y algunos tipos de dolor neuropatico. No obstante, no se dispone de datos sobre eficacia y seguridad a largo plazo. Aunque los antidepresivos triciclicos son eficaces para el dolor neuropatico, sus efectos anticolinergicos suponen un problema para el anciano. Antiepilepticos como gabapentina y pregabalina son eficaces para el dolor neuropatico y mejor tolerados. La administracion topica de algunos farmacos mejora la tolerabilidad de los mismos. EnglishThere is a small number of primary studies relating to opioid use in older people. In carefully selected and monitored patients, opioids may provide effective pain relief as part of comprehensive pain management strategy. Use of strong opioids in the management of chronic, severe cancer and non-cancer pain in older people has been reviewed. Studies have demonstrated short-term efficacy in persistent musculoskeletal pain and various neuropathic pains. However, longer-term efficacy and safety data are lacking. Some adjuvant drugs should be considered for older people with neuropathic. Although tricyclic antidepressants have good efficacy, anticholinergic side effects are often problematic for older people. Anti-epileptic drugs such as gabapentin or pregabalin, are effective for neuropathic pain and are probably better tolerated. Topical administration may have improved tolerability than other routes of administration and may be preferable for elderly.