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Thomas Eko P
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Medicine & Pharmacology

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PHARMACOTHERAPY IN ELDERLY NEUROPATHIC PAIN Eko P, Thomas
Medicina Vol 44 No 1 (2013): Januari 2013
Publisher : Medicina

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Abstract

The incidence of pain increases with age. Neuropathic pain are common in elderly patients and pose challenges in both their diagnosis and treatment. The most common neuropathic pain in elderly are radiculopathy due to foraminal or spinal stenosis, diabetic neuropathy, and postherpetic neuralgia. Pain in the elderly is often unrecognized and undertreated. The main problem with pain in older adults relates to impaired quality of life secondary to pain which may be expressed by depression (including increased suicide risk), anxiety, sleep disruption, appetite disturbance, and weight loss, cognitive impairment, and limitations in the performance of daily activities. Pain management in elderly patients requires a different perspective from that of younger patients. Causes, comorbidities, and responses to both pain and its treatment differ between young healthy and older patients. Effective pain management in elderly patients should include both pharmacologic and nonpharmacologic strategies. Pharmacological approaches are the first line of pain management in older person for neuropathic pain. Pharmacologic strategies call for administration of nonopioid analgesics, opioid analgesics, and adjuvant medication. Polypharmacy, drug-drug and drug-disease interactions, age-associated changes in drug metabolism, and the high frequency of adverse drug reactions need to be carefully considered in using medications in this population
THE USE COXIB IN NOCICEPTIVE PAIN MANAGEMENT Eko P, Thomas
Medicina Vol 43 No 1 (2012): Januari 2012
Publisher : Medicina

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Abstract

The advent of the Coxibs (COX-2 inhibitor) represented a significant theorical breakthrough in non-steroid anti inflammatory drugs (NSAIDs) treatment. The use of   NSAIDs is limited by by adverse reactions, especially their gastrointestinal (GI) toxicity. The selective COX-2 inhibitors were originally developed to minimize the adverse effect of conventional NSAIDs while maintaining the same analgesic and anti-inflammatory effects. Although the benefit of coxibs  in GI tract has been established the cardiovascular (CV) safety of coxibs still debatable. Several studies have reported an increased incidence of   cardiovascular related morbidity and mortality with the use of COX-2 inhibitor. A definitive answer to whether or not these drugs increase CV risk can only really be derived from multicenter purpose-designed, prospective randomized control trials. Circumstances under which COX-2 selective inhibitor  maybe appropriate are in patients at high GI risk and in patients who did not respond to multiple conventional NSAIDs. Health care providers must consider the efficacy, GI and CV risks, concomitant medications and costs when determining the appropriateness of COX-2 selective inhibitor therapy.(MEDICINA 2012;43:23-30).
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