Addiction should not be an issue for prescribers, and patients should be reassured that fear of addiction should not affect their use of the drug. Timed-release morphine and oxycodone as well as transdermal fentanyl relieve baseline pain. Fast-acting drugs, such as hydrocodone, oxycodone, morphine, hydromorphone, and transmucosal fentanyl lollipops, relieve intermittent or breakthrough pain. Fentanyl clearance is decreased in the elderly. Methadone, meperidine, pentazocine, and propoxyphene should not be used in the elderly.
Stimulant laxatives are essential for an elderly patient receiving opioid therapy.
Elderly patients may become somnolent while being treated with opioids. Methylphenidate, taken periodically at a dose of 5 to 10 mg, is often useful, especially for those patients desiring more social interaction when taking opioids. Pain not relieved by opioids requires adjunctive treatment. Antidepressants, anticonvulsants, or antiarrhythmics may be used for neuropathic pain. Epidural or intrathecal opioids or clonidine infusion may be extremely effective without causing side effects.