Side Effects From Oral Opioids in Older Adults During the First Week of Treatment for Acute Musculoskeletal Pain

Objectives The authors sought to describe the frequency of short-term side effects experienced by older adults initiating treatment with opioid-containing analgesics for acute musculoskeletal pain. Methods This was a cross-sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid-related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects. Propensity score matching was used to compare side effects among patients initiating treatment with any opioid-containing analgesics to side effects among those initiating treatment with only nonopioids. Results Of 104 older patients initiating analgesic treatment following ED visits for musculoskeletal pain, 71 patients took opioid-containing analgesics, 15 took acetaminophen, and 18 took ibuprofen. Among the patients who took opioids, at least one side effect of moderate or severe intensity (score ≥ 4) was reported by 62%. Among patients with matching propensity scores, those taking opioids were more likely to have had moderate or severe side effects than those taking only nonopioids (62%, 95% confidence interval [CI] = 48% to 74% vs. 4%, 95% CI = 1% to 20%) and were also more likely to have discontinued treatment due to side effects (16%, 95% CI = 8% to 29% vs. 0%, 95% CI = 0% to 13%). The most common side effects due to opioids were tiredness, nausea, and constipation. Conclusions Among older adults initiating treatment with opioid-containing analgesics for musculoskeletal pain, side effects were common and sometimes resulted in medication discontinuation. Resumen Efectos Secundarios de los Opioides Orales Utilizados para Tratar el Dolor Agudo Musculoesqueletico en Adultos Mayores Durante la Primera Semana de Tratamiento Objetivos Describir la frecuencia de los efectos secundarios a corto plazo experimentados por los adultos mayores que inician tratamiento con un analgesico que contiene opioides para el dolor agudo musculoesqueletico. Metodologia Estudio transversal de sujetos de 65 anos o mas que iniciaron tratamiento analgesico tras una visita al servicio de urgencias (SU) por dolor agudo musculoesqueletico. Se contacto con los pacientes por telefono de 4 a 7 dias despues de la visita al SU para valorar la intensidad de los seis efectos secundarios mas frecuentes relacionados con los opiaceos usando una escala de 0 a 10. Se valoro la interrupcion de la medicacion debido a los efectos secundarios. Se utilizo el emparejamiento mediante puntuacion de propension (propensity store) para comparar los efectos secundarios entre los pacientes que inician el tratamiento con cualquier analgesico que contiene opioides y los efectos secundarios en aquellos que inician tratamiento unicamente con no opioides. Resultados De los 104 pacientes mayores que iniciaron tratamiento analgesico tras una visita al SU por dolor musculoesqueletico, 71 tomaron un analgesico que contenia opioides, 15 acetaminofeno y 18 ibuprofeno. Entre los pacientes que tomaron un opioide, al menos se documento un efecto secundario de intensidad moderada o grave (puntuacion ≥ 4) en el 62% de ellos. Entre los pacientes con emparejamiento mediante puntuaciones de propension, aquellos que tomaron opioides tuvieron mayor probabilidad de haber tenido un efecto secundario moderado o grave que aquellos que tomaron unicamente un no opioide (62%, intervalo de confianza [IC] 95% = 48% a 74% vs. 4%, IC 95% = 1% a 20%) y tambien tuvieron mayor probabilidad de haber interrumpido el tratamiento debido a los efectos secundarios (16%, IC 95% = 8% a 29% vs. 0%, IC 95% = 0% a 13%). Los efectos secundarios mas frecuentes debido a los opioides fueron cansancio, nauseas y estrenimiento. Conclusiones En los adultos mayores que inician tratamiento analgesico que contiene opioides para el dolor musculoesqueletico, los efectos secundarios fueron comunes y algunas veces llevaron a la interrupcion de la medicacion.