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Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study.

https://arctichealth.org/en/permalink/ahliterature106722
Source
Reg Anesth Pain Med. 2013 Nov-Dec;38(6):526-32
Publication Type
Article
Author
Pia Jæger
Dusanka Zaric
Jonna S Fomsgaard
Karen Lisa Hilsted
Jens Bjerregaard
Jens Gyrn
Ole Mathiesen
Tommy K Larsen
Jørgen B Dahl
Author Affiliation
From the *Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen; ‚ĆDepartment of Anaesthesia, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg; ‚Ä°Department of Anaesthesia, Glostrup Hospital, Copenhagen University Hospital, Glostrup; §Section of Acute Pain Management, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen; and ?Department of Surgery, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
Source
Reg Anesth Pain Med. 2013 Nov-Dec;38(6):526-32
Language
English
Publication Type
Article
Keywords
Aged
Amides - administration & dosage
Analgesics, Opioid - therapeutic use
Anesthesia, Spinal
Anesthetics, Local - administration & dosage
Arthroplasty, Replacement, Knee - adverse effects
Denmark
Double-Blind Method
Female
Femoral Nerve
Humans
Infusions, Parenteral
Male
Middle Aged
Morphine - therapeutic use
Muscle strength
Muscle Weakness - etiology - physiopathology
Nerve Block - adverse effects - methods
Pain, Postoperative - diagnosis - etiology - prevention & control
Prospective Studies
Quadriceps Muscle - innervation
Recovery of Function
Time Factors
Treatment Outcome
Abstract
Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, adductor muscle strength, morphine-related complications, and mobilization ability.
We performed a double-blind, randomized, controlled study of patients scheduled for TKA with spinal anesthesia. The patients were randomized to receive either a continuous ACB or an FNB via a catheter (30-mL 0.5% ropivacaine given initially, followed by a continuous infusion of 0.2% ropivacaine, 8 mL/h for 24 hours). Muscle strength was assessed with a handheld dynamometer, and we used the percentile change from baseline for comparisons. The trial was registered at clinicaltrials.gov (Identifier: NCT01470391).
We enrolled 54 patients, of which 48 were analyzed. Quadriceps strength as a percentage of baseline was significantly higher in the ACB group compared with the FNB group: (median [range]) 52% [31-71] versus 18% [4-48], (95% confidence interval, 8-41; P = 0.004). There was no difference between the groups regarding morphine consumption (P = 0.94), pain at rest (P = 0.21), pain during flexion of the knee (P = 0.16), or adductor muscle strength (P = 0.39); neither was there a difference in morphine-related adverse effects or mobilization ability (P > 0.05).
Adductor canal block preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain.
Notes
Comment In: Reg Anesth Pain Med. 2014 May-Jun;39(3):253-424747312
Comment In: Reg Anesth Pain Med. 2014 May-Jun;39(3):263-424747322
Comment In: Reg Anesth Pain Med. 2014 May-Jun;39(3):254-524747313
Comment In: Reg Anesth Pain Med. 2014 May-Jun;39(3):26424747323
PubMed ID
24121608 View in PubMed
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[Analgesia after orthopedic interventions]

https://arctichealth.org/en/permalink/ahliterature10435
Source
Klin Khir. 2000;(3):33-5
Publication Type
Article
Date
2000
Author
M K Ternovyi
O M Kosiakov
I M Zazirnyi
V H Ievsieienko
Source
Klin Khir. 2000;(3):33-5
Date
2000
Language
Ukrainian
Publication Type
Article
Keywords
Analgesics, Opioid - therapeutic use
Comparative Study
English Abstract
Humans
Orthopedic Procedures - methods
Pain - drug therapy
Postoperative Care
Tramadol - therapeutic use
Treatment Outcome
Abstract
The efficacy of application of tramadol and naclofen for analgesia after performance of orthopedic operations was studied up. There were examined 112 patients, to whom were done total endoprosthesis of coxofemoral joint, 19--total endoprosthesis of the knee joint, 54--the knee joint arthroscopy. The analgesia efficacy was estimated according to visual-analogue scale and to the sensations index. High efficacy of the tramadol application for postoperative analgesia was established. In patients, to whom tramadol and naclofen were administered, maximal analgetic effect was noted.
PubMed ID
10857311 View in PubMed
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Analgesic prescribing patterns in Norwegian nursing homes from 2000 to 2011: trend analyses of four data samples.

https://arctichealth.org/en/permalink/ahliterature276993
Source
Age Ageing. 2016 Jan;45(1):54-60
Publication Type
Article
Date
Jan-2016
Author
Reidun Sandvik
Geir Selbaek
Oyvind Kirkevold
Dag Aarsland
Bettina Sandgathe Husebo
Source
Age Ageing. 2016 Jan;45(1):54-60
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Acetaminophen - therapeutic use
Age Factors
Aged
Aged, 80 and over
Aging - psychology
Analgesics - therapeutic use
Analgesics, Non-Narcotic - therapeutic use
Analgesics, Opioid - therapeutic use
Chi-Square Distribution
Cognition
Dementia - psychology
Drug Prescriptions
Drug Utilization Review
Female
Homes for the Aged - trends
Humans
Logistic Models
Male
Multivariate Analysis
Norway
Nursing Homes - trends
Observational Studies as Topic
Odds Ratio
Practice Patterns, Physicians' - trends
Randomized Controlled Trials as Topic
Time Factors
Abstract
the analgesic drug use has been reported to increase in general in nursing home patients. However, there is insufficient evidence in terms of what agents are used, variations of use over time and to whom these drugs are prescribed.
we investigated the prescribing patterns of scheduled analgesic drugs in Norwegian nursing home patients from 2000 to 2011, with the association to age, gender, cognitive function and type of nursing home unit.
secondary analyses of four study samples (three observational studies and one randomised controlled trial).
nursing home patients included in study samples from 2000 (n = 1,926), 2004 (n = 1,163), 2009 (n = 850) and 2011 (n = 1,858) located in 14 Norwegian counties.
trend analyses of analgesic drug prescriptions. Percentages were described using t-test, ?(2) and Mann-Whitney U test and multivariate logistic regression.
the odds ratio for receiving any pain medication in 2011 compared with 2000 was 2.6 (95% CI 2.23-2.91), this is corresponding to a 65% increase from 34.9 to 57.6%. The paracetamol prescription increased by 113%, from 22.7% in 2000 to 48.4% in 2011. Strong opioids (fentanyl, buprenorphine, morphine, oxycodone) increased from 1.9% in 2000 to 17.9% in 2011 (P
Notes
Comment In: Age Ageing. 2016 Jan;45(1):7-826764389
Erratum In: Age Ageing. 2016 Mar;45(2):32326941355
PubMed ID
26764395 View in PubMed
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Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study.

https://arctichealth.org/en/permalink/ahliterature142226
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Publication Type
Article
Date
Jun-2010
Author
Niina Pokela
J Simon Bell
Katri Lihavainen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Analgesics - therapeutic use
Analgesics, Opioid - therapeutic use
Cross-Sectional Studies
Data Collection
Depression - complications
Female
Finland
Health status
Humans
Male
Multivariate Analysis
Pain - drug therapy
Polypharmacy
Residence Characteristics - statistics & numerical data
Sex Factors
Abstract
Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.
The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.
A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).
Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.
Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.
PubMed ID
20624613 View in PubMed
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Assessing the prevalence of nonmedical prescription opioid use in the general Canadian population: methodological issues and questions.

https://arctichealth.org/en/permalink/ahliterature140818
Source
Can J Psychiatry. 2010 Sep;55(9):606-9
Publication Type
Article
Date
Sep-2010
Author
Benedikt Fischer
Nadine Nakamura
Anca Ialomiteanu
Angela Boak
Jürgen Rehm
Author Affiliation
Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, British Columbia, Canada. bfischer@sfu.ca
Source
Can J Psychiatry. 2010 Sep;55(9):606-9
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Analgesics, Opioid - therapeutic use
Canada - epidemiology
Cross-Sectional Studies
Drug Prescriptions - statistics & numerical data
Female
Health Surveys - methods - standards
Humans
Male
Middle Aged
Opioid-Related Disorders - epidemiology
Prevalence
Sex Factors
Abstract
To assess the prevalence of nonmedical prescription opioid use (NMPOU) in the Canadian general adult population in the context of rising overall prescription opioid (PO) consumption and related problems in North America.
The prevalence of NMPOU was assessed as a multiitem construct in the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS; n = 16 672), an ongoing cross-sectional monthly random digit dialing telephone survey representative of the general Canadian population, aged 15 years and older. CADUMS data were collected between April and December of 2008 with a response rate of 43.5%.
About 22% of CADUMS respondents reported PO use in the last year, while 0.5% reported NMPOU during the same time frame. PO use was significantly higher among women than among men, and highest in the group aged 25 to 54 years. NMPOU was similar among men and women, and highest in the group aged 15 to 24 years.
CADUMS data indicate an extremely low rate of NMPOU, especially given the levels of overall PO use, other PO-use related problems, and NMPOU levels estimated in the general US population where NMPOU has been assessed to be 10 times higher than in Canada. NMPOU survey item construction and response rates appear to strongly influence and potentially compromise NMPOU survey data. Existing NMPOU data and survey methods need to be validated for this important indicator in Canada, where increasing PO use and problem levels have been recognized as a significant and rising public health problem.
PubMed ID
20840808 View in PubMed
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The association between prescribed opioid use for mothers and children: a record-linkage study.

https://arctichealth.org/en/permalink/ahliterature123599
Source
Eur J Clin Pharmacol. 2013 Jan;69(1):111-8
Publication Type
Article
Date
Jan-2013
Author
Tomas Log
Svetlana Skurtveit
Randi Selmer
Aage Tverdal
Kari Furu
Ingeborg Hartz
Author Affiliation
Department of Pharmacy, University of Tromsø, 9037 Tromsø, Norway. tomas.log@uit.no
Source
Eur J Clin Pharmacol. 2013 Jan;69(1):111-8
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Analgesics, Opioid - therapeutic use
Databases, Factual
Female
Humans
Male
Middle Aged
Mothers - statistics & numerical data
Norway
Registries
Abstract
The repeated use of prescription opioids may lead to serious side effects. It is therefore important to examine factors associated with such repeated use. The aim of this study was to investigate the association between the maternal use of prescription opioids and their use by offspring of these mothers.
Data were extracted from two nationwide registers linked by unique personal identity numbers: the 2001 Norwegian Population and Housing Census and the Norwegian Prescription Database 2004-2009. The study population consisted of 97,574 adolescents aged 15-16 years in 2001 and their mothers. The repeated use of opioids was defined as the issuing of >4 and >15 prescriptions to an adolescent and his/her mother, respectively, during the period 2004-2009. Non-steroidal anti-inflammatory drugs (NSAIDs) are not potentially addictive, and individuals issued prescriptions for NSAIDs were used as the reference analgesic drug group.
The proportion of repeated prescription opioid users was higher among adolescents whose mother was registered as a repeated user of prescription opioids (8.4 %) than among those whose mother did not repeatedly use prescription opioids (2.4 %). The odds ratio (OR) was 3.1 [95 % confidence interval (CI) 2.7-3.6] when adjusted for the mother's socioeconomic characteristics and the gender of the offspring. A lower socioeconomic position of the mother increased the risk of repeated opioid use by her offspring. Maternal repeated use of NSAIDs was associated with repeated use of NSAIDs among offspring (OR 1.8, 95 % CI 1.7-2.0).
Among our study population, the maternal use of opioids was associated with the repeated use of prescription opioids among the respective offspring. The same association was seen with NSAIDs, but to a lesser extent.
PubMed ID
22684128 View in PubMed
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Atropine, fentanyl and succinylcholine for non-urgent intubations in newborns.

https://arctichealth.org/en/permalink/ahliterature151909
Source
Arch Dis Child Fetal Neonatal Ed. 2009 Nov;94(6):F439-42
Publication Type
Article
Date
Nov-2009
Author
B. Lemyre
R. Cheng
I. Gaboury
Author Affiliation
University of Ottawa, Ottawa, Ontario, Canada. blemyre@toh.on.ca
Source
Arch Dis Child Fetal Neonatal Ed. 2009 Nov;94(6):F439-42
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adjuvants, Anesthesia - therapeutic use
Age Factors
Analgesics, Opioid - therapeutic use
Atropine - therapeutic use
Canada
Fentanyl - therapeutic use
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Intensive Care, Neonatal - methods
Intubation, Intratracheal - adverse effects - methods
Neuromuscular Depolarizing Agents - adverse effects - therapeutic use
Premedication - adverse effects - methods
Prospective Studies
Succinylcholine - adverse effects - therapeutic use
Treatment Outcome
Abstract
Describe intubation conditions and adverse events when using atropine fentanyl +/- succinylcholine as premedication.
Prospective observational study, as part of a quality improvement initiative.
Two level 3 neonatal intensive care units in Ottawa, Canada
60 infants, median 27 weeks gestation, 1023 g at birth were included.
Infants received atropine, fentanyl +/- succinylcholine prior to the intubation. Succinylcholine was given for all infants > or =34 weeks and at the discretion of the physician for those
PubMed ID
19307222 View in PubMed
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Attitudes toward opioid use for chronic pain: a Canadian physician survey.

https://arctichealth.org/en/permalink/ahliterature182348
Source
Pain Res Manag. 2003;8(4):189-94
Publication Type
Article
Date
2003
Author
Patricia K Morley-Forster
Alexander J Clark
Mark Speechley
Dwight E Moulin
Author Affiliation
University of Western Ontario Interdisciplinary Pain Program, St. Joseph's Health Care, London, Ontario, Canada. pat.morley-forster@sjhc.london.on.ca
Source
Pain Res Manag. 2003;8(4):189-94
Date
2003
Language
English
Publication Type
Article
Keywords
Analgesics, Opioid - therapeutic use
Attitude of Health Personnel
Canada
Chronic Disease
Data Collection
Drug Prescriptions
Humans
Interviews as Topic
Opioid-Related Disorders - etiology
Pain - drug therapy - psychology
Pain Measurement - methods
Palliative Care
Physicians
Abstract
To measure chronic pain patient volumes seen in primary care practice; to determine what medications physicians choose for the treatment of moderate to severe chronic pain; to identify barriers to the use of opioids in the treatment of chronic pain; and to assess physicians' attitudes toward the current management of chronic pain in Canada.
A computer-assisted telephone survey of 100 regionally representative Canadian physicians with a defined interest in palliative care (PC, n=30) or noncancer pain (GP, n=70).
A survey was conducted by Ipsos-Reid in June 2001. Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of time to palliative care were eligible to participate.
In one month, the average number of patients with moderate to severe chronic pain seen by PCs was 94.2; the average seen by GPs was 44.7. The pain experienced by 83.3% of GP patients was noncancer related. For chronic cancer pain, an opioid analgesic was the treatment of choice of 79% of physicians (48% preferred morphine, 21% codeine, 10% other). For moderate to severe chronic noncancer pain, opioids were the first-line treatment of only 32% of physicians (16% preferred codeine, 16% major opioids) because a significant number preferred either non-steroidal anti-inflammatory drugs (29%) or acetaminophen (16%). Thirty-five per cent of GPs and 23% of PCs would never use opioids for noncancer pain, even when described as severe. Chronic pain was deemed by 68% of physicians to be inadequately managed. Almost 60% thought that pain management could be enhanced by improved physician education. Identified barriers to opioid use included addiction potential (37%) and side effects (25%). Seventeen per cent of GPs and 10% of PCs thought that regulatory sanctions limited opioid prescribing.
Even among physicians experienced in chronic pain treatment, there is a reluctance to use opioids for severe nonmalignant pain. One-half of the survey participants believed that there was a need for improved physician education in pain management, including the use of opioids.
Notes
Comment In: Pain Res Manag. 2003 Winter;8(4):187-814679411
PubMed ID
14679412 View in PubMed
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Backlash in the treatment of cancer pain: use of opioid analgesics in a Finnish general hospital in 1987, 1991, and 1994.

https://arctichealth.org/en/permalink/ahliterature207235
Source
J Pain Symptom Manage. 1997 Nov;14(5):286-91
Publication Type
Article
Date
Nov-1997
Author
E. Vuorinen
A. Vainio
A. Reponen
Author Affiliation
Kymenlaakso Central Hospital, Kotka, Finland.
Source
J Pain Symptom Manage. 1997 Nov;14(5):286-91
Date
Nov-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Analgesics, Opioid - therapeutic use
Female
Finland
Hospitals, General
Humans
Male
Middle Aged
Neoplasms - complications
Pain - drug therapy
Physician's Practice Patterns - trends
Abstract
Finland belongs to the group of countries in which the consumption of strong opioids is low. This seems to reflect the general quality of cancer pain treatment. During the last 10 years, many efforts have been made to improve the treatment of cancer pain in Finland. To assess one parameter of change, the present study compared the quantity of opioid and nonopioid analgesics used in the treatment of terminal cancer pain in a Finnish general hospital in 1987, 1991, and 1994. Specifically, the records of all patients who died of cancer in Kymenlaakso Central Hospital (KCH) in 1991 and in 1994 and during the last 6 months of 1987 were reviewed to acquire information about the use of analgesic medication. The total proportion of cancer patients receiving analgesic medication on a regular basis was 39% in 1987, 63% in 1991, and 52% in 1994. The mean daily dose of strong opioids changed from 24 mg in 1987 to 58 mg in 1991, and to 43 mg in 1994. These data suggest a possible backlash in prescribing practices during recent years. In spite of various efforts to improve the treatment of cancer pain, the medical records demonstrate a decline in prescribing of the drugs needed for this treatment.
PubMed ID
9392922 View in PubMed
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Balancing pain and analgesic treatment in the home-dwelling elderly.

https://arctichealth.org/en/permalink/ahliterature176975
Source
Ann Pharmacother. 2005 Jan;39(1):11-6
Publication Type
Article
Date
Jan-2005
Author
Sirpa A Hartikainen
Pekka T Mäntyselkä
Kirsti A Louhivuori-Laako
Raimo O Sulkava
Author Affiliation
Division of Geriatrics, Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland. Sirpa.Hartikainen@uku.fi
Source
Ann Pharmacother. 2005 Jan;39(1):11-6
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Acetaminophen - therapeutic use
Aged
Aged, 80 and over
Analgesics - therapeutic use
Analgesics, Non-Narcotic - therapeutic use
Analgesics, Opioid - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Drug Utilization
Female
Finland - epidemiology
Humans
Male
Pain - drug therapy - epidemiology
Residence Characteristics
Abstract
In elderly persons, pain is a common problem, and analgesic medicines are among the most frequently used drugs.
To describe the use of analgesic medication and its relation to daily pain and morbidity in home-dwelling elderly people aged at least 75 years.
A random sample of 700 subjects aged at least 75 years was drawn from the total population of Kuopio, Finland. A geriatrician and nurse carried out structured clinical examinations and interviews with 601 persons, 523 of whom were living at home.
Seventy percent (n = 364) of the elderly people were taking at least one analgesic, including most of those who suffered from daily interfering pain (85%) and nearly all of those experiencing daily pain at rest (93%). Nonsteroidal antiinflammatory drugs (NSAIDs; n = 226, 51%) and acetaminophen (n = 118, 23%) were the most commonly used analgesics. The use of opioids became more common with age, accounting for 16% of the drugs in the oldest patients (> or =85 y) and 6% among those aged 75-79 years. Analgesics were mainly taken when needed. Only 13% of NSAID users, 18% of acetaminophen users, and 21% of opioid users took these preparations regularly.
Although analgesics are commonly used by elderly patients, it appeared that many patients were still experiencing daily interfering pain and pain at rest.
PubMed ID
15598966 View in PubMed
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149 records – page 1 of 15.