Addiction is a psychological problem manifested by drug-seeking behavior. The symptoms of sudden withdrawal are similar to those seen with physical dependence but the clinician should not confuse the two. When designing a pain protocol for the elderly using opioids, Dr. Forman advised being aware of the increased sensitivity to the drugs and their unwanted effects. If the pain is chronic, use the agents on a fixed rather than as-needed schedule, and make sure the patient is fully informed of the degree of pain relief that can be achieved. Know the physiological changes that may alter the optimum dose in the elderly patient.
Creatinine clearance is a critical factor in opioid clearance.
Opioids are classified as weak or strong. The weak opioids, like codeine, administered orally, are usually tried first. When pain is not relieved with the weak opioids, the use of stronger drugs is recommended. Oxycodone, morphine, and hydromorphone are Dr. Forman's choices depending on the clinical situation. Morphine and oxycodone are available in sustained-release preparations.