Acute Postoperative Pain Management in the Older Patient

Thor Hallingbye; Jacob Martin; Christopher Viscomi


Aging Health. 2011;7(6):813-828. 

In This Article

Future Perspective

Opioids have ruled the pain management field for centuries, and rightfully wear the crown at the top of the WHO pain ladder. However, in the near future their reign will end. This will not be easily accomplished, but it is necessary. Opioids, while marvelous in their acute analgesic potential, carry unacceptable personal and societal risks. Addiction and abuse potential are both personal risks of opioids, but have also created widespread disruption of families, diminished work productivity and caused significant criminal behavior. In addition, respiratory depression, constipation and somnolence are just a few of the many risks associated with opioid use. Finally, over several months, opioids lose effectiveness (tolerance) or even contribute to pain (opioid-induced hyperalgesia). Older adults are just as vulnerable, if not more so, to these hazards. What will supplant opioids? It is likely that interventional pain management strategies, nonpharmacological approaches and medications with fewer risks will take on a greater role in the future. Specific classes of drugs such as NMDA receptors and TRPV1 receptor blockers are being developed and show great potential. Unfortunately, the first generation of these agents is limited by side effects. It is likely that in the next 5–10 years, next generation drugs in these classes will be available, and will supplant opioids as the mainstays of pain management.


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