Jackie Gardner-Nix, MB BS, PhD, MRCP(UK), Assistant Professor, University of Toronto; Chronic Pain Consultant, Department of Anesthesia, St Michael’s Hospital; and Pain Management Programme, Sunnybrook Health Sciences Centre, Toronto, ON.

The management of neuropathic pain at any age is aimed at the relief of suffering rather than focusing on decreasing pain scores, and it should involve even simple measures that affect pain and coping. Addressing physical stressors—poor diet, hydration, and sleep quality and quantity—is particularly relevant in older adults. Medications relieving neuropathic pain may be adjunctive to initial interventions and need to be carefully assessed for efficacy and side effects to ensure they relieve, rather than add to, suffering.
Key words: neuropathic pain, analgesics, older adults, mindfulness, psychological interventions.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme

Hsiupei Chen, MD, Carolina Pain Consultants and Critical Health Systems, Raleigh, North Carolina, USA.
Randall P. Brewer, MD, The Spine Institute, Willis Knighton Health System, Shreveport, Louisiana, USA.

Neuropathic pain (NP) results from injury or dysfunction in the processing of sensory information in the nervous system. It occurs in a wide array of disease processes and may involve complex management strategies. A comprehensive approach utilizing proven pharmacologic and nonpharmacologic therapies can be used to return function and improve quality of life that has been lost because of pain. In the older population, age-related physiologic and pharmacodynamic alterations, coexisting diseases, and the prevalence of polypharmacy must be considered when selecting therapies for neuropathic pain.
Key words: neuropathic pain, older adults, neuropathy, pain, analgesics.

In a word: maybe. Since 1980, several studies have examined whether the use of pain relievers is associated with various degrees of kidney failure. Some studies suggested no clear association but the majority found a link, particularly between the use of Tylenol and other acetaminophen.

A new group of researchers has entered the melee. The group did a cohort study of analgesic use data from the Physicians' Health Study, which lasted 14 years from September 1982 to December 1995, with annual follow-up. A total of 11,032 healthy men, who were between the ages of 40 and 84 at the start of the study, provided blood samples and self-reports of analgesic use. The main outcome measures of the study were elevated creatinine level defined as 1.5 mg/dL (133 mmol/L) or higher and a reduced creatinine clearance defined as 55 mL/min (0.9 mL/s) or less, and self-reported use of acetaminophen, aspirin and other NSAIDs. Patients were divided into groups of those who: never used analgesics (<12 pills); used 12-499 pills; used 1500-2,499 pills; and used = 2500 pills.

The study found that mean creatinine levels and creatinine clearance were similar among men who did not use analgesics and those who did, even at total intake of 2,500 or more pills. However, the study has drawn some criticism. Some researchers have judged the findings inconclusive, as the authors did not use a series of tests that could have more accurately assessed progression of kidney disease. Additionally, the study doesn't address whether similar results would be found in those patients who take several painkillers daily, or what the situation would be in women--who are disproportionately affected by conditions requiring pain medication such as arthritis and menstrual cramps.

Source

1. Rexrode KM, Buring JE, Glynn RJ, Stampfer MJ, Youngman LD, Gaziano, JM. Analgesic use and renal function in men. JAMA. 2001; 286:315-21.