Adequate @entity158 therapy is an important aspect in the treatment of the elderly @entity1 with @entity309 . Problems with traditional NSAIDs include potentially serious gastrointestinal, cardiovascular and renal adverse effects, especially in the elderly. In addition, the selective @entity3840 inhibitors have been associated with renal and cardiovascular adverse effects which may limit their use in the elderly with @entity65 . Opioids provide a treatment option for the management of @entity158 in elderly @entity1 with @entity309 in whom @entity158 control under standard management is poor; however, various therapeutic difficulties are encountered in the heterogeneous elderly population (increased risk of adverse effects, multimorbidity, and polypharmacy). Lower initial opioid dosage, prolonged dosage intervals and slower dosage titrations are advisable because of altered pharmacokinetics and pharmacodynamics. Kidney function should be tightly monitored and a timely use of laxatives is to be encouraged. Randomised clinical studies of opioids in @entity4512 (e.g. @entity571 ) have increasingly extended the scientific basis for their use. However, no randomised controlled clinical trials have examined the efficacy and the benefit/risk ratio of opioids in @entity309 . Opioids also demonstrate an analgesic effect following local peripheral application. This opens the way to new therapeutic options in the future through the development of systemic peripherally selective opioids without CNS adverse effects.

The role of opioid analgesics in XXXX in the elderly population.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity4512 :: ('MESH:D059352', 'Disease') :: ['musculoskeletal pain'] @entity571 :: ('MESH:D010003', 'Disease') :: ['osteoarthritis'] @entity309 :: ('MESH:D001172', 'Disease') :: ['rheumatoid arthritis', 'rheumatoid disease'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity3840 :: ('5743', 'Gene') :: ['cyclo-oxygenase-2'] @entity65 :: ('MESH:D002318', 'Disease') :: ['renal or cardiovascular disease']
@entity309 :: (MESH:D001172,Disease) :: ['rheumatoid disease']
