Approximately seven per cent of persons with Alzheimer's disease use strong pain medicines, opioids, for non-cancer pain for a period longer than six months, according to a recent study conducted at the University of Eastern Finland. One third of people initiating opioid use became long-term users, and long-term use was heavily associated with transdermal opioid patches. The results were published in PAIN.
The researchers found that long-term use of opioids was approximately as common among persons with Alzheimer's disease as it was among those without it. However, long-term use of transdermal patches was twice as common among persons with Alzheimer's disease, while tablet form opioids were more common among those without Alzheimer's disease. In addition, long-term opioid use together with benzodiazepines was common, which is worrying as both medicines cause drowsiness. The use of opioids was studied from the date of Alzheimer's disease diagnosis until death or admission into a long-term care facility. Those with active cancer treatment were excluded from the analysis.
Long-term opioid use is a problematic practice for non-cancer pain. Evidence of its benefits is limited, and the risk of adverse effects is increased compared to short-term treatment. Further, research on the benefits and adverse effects of long-term opioid use is very scarce among older adults and especially those with dementia. Changing doses and stopping medication when using patch-form opioids requires more time and thus, entails more careful monitoring. Pain, the need for analgesics, and possible adverse effects related to analgesics should be assessed regularly among persons with dementia.
The study is part of the MEDALZ cohort, which included 67,215 persons with Alzheimer's disease diagnosed during 2005-2011, of whom 13,111 initiated opioid use. Each person with the disease was matched with a comparison person without Alzheimer's disease of the same age, gender and region of residence. Data for the study were derived from Finnish nationwide registers.
For more information, please contact: Aleksi Hamina, MSc (Pharm), PhD student, School of Pharmacy, University of Eastern Finland, Kuopio, aleksi.hamina(at)uef.fi
Heidi Taipale, post-doctoral researcher, School of Pharmacy, University of Eastern Finland, heidi.taipale(at)uef.fi
Research article: Long-term use of opioids for non-malignant pain among community-dwelling persons with and without Alzheimer's disease in Finland: a nationwide register-based study. Aleksi Hamina, Heidi Taipale, Antti Tanskanen, Anna-Maija Tolppanen, Niina Karttunen, Liisa Pylkkänen, Jari Tiihonen, Sirpa Hartikainen. PAIN, published online 14 November 2016. doi: 10.1097/j.pain.0000000000000752