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

• Published in: Clinical interventions in aging 2016-01, Vol.11, p.641-649
• Main Authors: Lazzari, Marzia, Marcassa, Claudio, Natoli, Silvia, Carpenedo, Roberta, Caldarulo, Clarissa, Silvi, Maria B, Dauri, Mario
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analgesics; Analgesics, Opioid - adverse effects; Antidepressants; Cancer therapies; Chronic pain; Chronic Pain - drug therapy; Cognitive ability; Constipation; Constipation - chemically induced; Delayed-Action Preparations - administration & dosage; Dosage and administration; Drug Combinations; Drug dosages; Drug therapy; elderly; Elderly patients; Female; Humans; Internet; Italy; Laxatives; Male; Methods; Naloxone; Naloxone - administration & dosage; Naloxone - adverse effects; Narcotics; Nonsteroidal anti-inflammatory drugs; Older people; opioid; Opioids; Original Research; Oxycodone; Oxycodone - administration & dosage; Oxycodone - adverse effects; Pain; Pain management; Pain Measurement; Patients; Quality of Life; Retrospective Studies; Review boards; Severity of Illness Index; Substance abuse treatment
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S105821

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. 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. 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