[Non-opioid pain medication in the elderly]

[Pharmacology of non-opioid analgesics]

Due to high prescription rates as well as the frequent use as over the counter drugs, it is of interest to consider non-opioid analgesics when evaluating the quality and appropriateness of a given overall medication. This article sums up the basic pharmacology and main adverse effects of these analgesics. Non-opioids can be further classified according to their additional mechanisms of action besides analgesia. High-dose acetylsalicylic acid, traditional nonsteroidal anti-inflammatory drugs, and coxibs exhibit antipyretic and anti-inflammatory properties. Acetaminophen and metamizole (dipyrone) are analgesics and antipyretic agents, while metamizole exhibits also spasmolytic effects. Capsaicin and intrathecal ziconotide are pure analgesics.

Screening for physical and behavioral dependence on non-opioid analgesics in a German elderly hospital population

OBJECTIVE

To provide further evidence of dependence on non-opioid analgesics (NOAs).

METHODS

Post-hoc-analysis of a cross-sectional study of a ≥ -65-year-old non-demented German general hospital population. Four hundred in-patients (75 ± 6.4 years; 63% females) were included and screened for current and past dependence on NOAs using a structured interview (SKID-I) based on DSM-IV-TR. The addiction section of SKID-I was expanded to the following NOAs: gabapentinoids, acetaminophen, metamizole, flupirtine, and non-steroidal anti-inflammatory drugs (NSAIDs).

RESULTS

We found twenty-eight seniors (7%) who fulfilled the criteria for a NOA-dependence. Of whom, twenty-four and four patients were currently dependent and in remission, respectively. According to SKID-I, twenty-one (75%) patients were mildly, five patients (17.9%) moderately, and two (7.1%) patients severely dependent on NOAs. All patients showed at least one sign of physical dependence (tolerance and/or withdrawal symptoms) and most of them reported additional behavioral dependence symptoms. Whereas there was one dependence on gabapentinoids or acetaminophen only, NSAIDs and metamizole were involved in the majority of cases (n = 25; 89.3%). Of note, ten (35.7%) seniors had a de-novo substance dependence exclusively on NOAs - including 2 females with signs of a de-novo dependence on metamizole, a NOA which yet has been not in the focus of addiction medicine.

CONCLUSION

This cross-sectional study provides further evidence of the existence of a physical and behavioral dependence on NOAs including NSAIDs. Furthermore, preliminary evidence of a de-novo dependence on metamizole is provided which needs further verification.