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Evaluation of pain control in osteoarthritis in the elderly using tramadol hydrochloride
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EVALUATION OF PAIN CONTROL IN OSTEOARTHRITIS IN THE ELDERLY -1 USING TRAMADC L HYDROCHLORIDE Exhibit Hall M.A. Horan: Senior Lecturer, University of Manchester, Hope Hospital, Salford, U.K. Abs No 68 R-S. Gulati: Consultant, Department of Geriatric Medicine, Victoria Hospital, Blackpool, U.K. (Sponsor: Mr. Durra, West Germany) AIM: To evaluate the role of a new opioid agonist, tramadol hydrochloride, in the relief ofain due to degenerative joint disease, and to assess its tolerability over a two week period. METHOD: This study was a placebo-controlled double-blind randomised comparison of oral tramadol hydrochloride capsules and oral placebo capsules administered 1-2 capsules 4-6 hourly over 14 days. The patients were selected from three aetiological populations using a factorial design, and completed daily pain relief assessments using Visual Analogue Scales; in addition a structured Questionnaire and clinical assessment was performed before, during and after treatment. RESULTS: 36 elderly patients, 23 female, aged between 64 and 90 years (80.6 +/- 6.11, the majority suffering from chronic pain (12 +/- 5.6 years) arising from multiple sites and, one patient excepting, with one or more concomitant diseases, were included. Analysis of pain relief showed superiority of the active compound, which due to the high placebo response rate Twell known in the elderly suffering from chronic benign pain) and the relatively small groups, did not reach statistical significance. CONCLUSIONS: The treatment of chronic benign pain with currently available opioids in the U.K. in the very elderly is fraught with difficulties - lack of compliance, wayward self-medication, unacceptable side-effects e.g. constipation, etc. These we will discuss further. We demonstrated that tramadol was well tolerated, and could be considered an interesting alternative to long-term NSAID therapy, in addition to replacing our current weak opioid repertoire.
PAIN IN THE ELDERLY IN THE IMMEDIATE POSTOPERATIVE PERIOD FOLLOWING COR$$?ftyY ARTERY BYPASS GRAB?. Sheldon L. Burchman W. Dudley2Johnson , Departments of 'Anesthesiology and Family f;
ractice,
Medical
College
of
Wisconsin,
GREY Mon-Tues
and
Department of Surgery, St. Mary's Hospital, Milwaukee, Wisconsin USA. AIM OF INVESTIGATION: This is a clinical observation based on 160 patients over the age of 60 , who presented with objective evidence of pain which was unrelieved by routine postoperative treatment plans. The intubated, ventilator dependent, and non communicating patient is most challenging to a Pain Management Specialist. A 2 year experience with intravenous Haloperidol (Haldol) confirms the unique and innovative properties of this agent in this setting to relieve pain and agitation in the elderly. METHODS: Intravenous Haloperidol (Haldol) used on a scheduled 30 minutes regimen, combined with lorazepam (Ativan) and modest opioids, (Morphine) will serve in most cases to decrease agitation, decrease pain, and restore the patient's compatibility with the ventilator. RESULTS: A restoration of calm, a diminished amount of objective pain, a stability in measurable hemodynamics with improvement of the respiratory status. Early extubation is a priority. CONCLUSION: There is an urgent need to individualize postoperative treatment plans especially in the elderly, over the age of 60.
EVALUATION OF PAIN CONTROL IN OSTEOARTHRITIS IN THE ELDERLY -1 USING TRAMADC L HYDROCHLORIDE Exhibit Hall M.A. Horan: Senior Lecturer, University of Manchester, Hope Hospital, Salford, U.K. Abs No 68 R-S. Gulati: Consultant, Department of Geriatric Medicine, Victoria Hospital, Blackpool, U.K. (Sponsor: Mr. Durra, West Germany) AIM: To evaluate the role of a new opioid agonist, tramadol hydrochloride, in the relief ofain due to degenerative joint disease, and to assess its tolerability over a two week period. METHOD: This study was a placebo-controlled double-blind randomised comparison of oral tramadol hydrochloride capsules and oral placebo capsules administered 1-2 capsules 4-6 hourly over 14 days. The patients were selected from three aetiological populations using a factorial design, and completed daily pain relief assessments using Visual Analogue Scales; in addition a structured Questionnaire and clinical assessment was performed before, during and after treatment. RESULTS: 36 elderly patients, 23 female, aged between 64 and 90 years (80.6 +/- 6.11, the majority suffering from chronic pain (12 +/- 5.6 years) arising from multiple sites and, one patient excepting, with one or more concomitant diseases, were included. Analysis of pain relief showed superiority of the active compound, which due to the high placebo response rate Twell known in the elderly suffering from chronic benign pain) and the relatively small groups, did not reach statistical significance. CONCLUSIONS: The treatment of chronic benign pain with currently available opioids in the U.K. in the very elderly is fraught with difficulties - lack of compliance, wayward self-medication, unacceptable side-effects e.g. constipation, etc. These we will discuss further. We demonstrated that tramadol was well tolerated, and could be considered an interesting alternative to long-term NSAID therapy, in addition to replacing our current weak opioid repertoire.
PAIN IN THE ELDERLY IN THE IMMEDIATE POSTOPERATIVE PERIOD FOLLOWING COR$$?ftyY ARTERY BYPASS GRAB?. Sheldon L. Burchman W. Dudley2Johnson , Departments of 'Anesthesiology and Family f;
ractice,
Medical
College
of
Wisconsin,
GREY Mon-Tues
and
Department of Surgery, St. Mary's Hospital, Milwaukee, Wisconsin USA. AIM OF INVESTIGATION: This is a clinical observation based on 160 patients over the age of 60 , who presented with objective evidence of pain which was unrelieved by routine postoperative treatment plans. The intubated, ventilator dependent, and non communicating patient is most challenging to a Pain Management Specialist. A 2 year experience with intravenous Haloperidol (Haldol) confirms the unique and innovative properties of this agent in this setting to relieve pain and agitation in the elderly. METHODS: Intravenous Haloperidol (Haldol) used on a scheduled 30 minutes regimen, combined with lorazepam (Ativan) and modest opioids, (Morphine) will serve in most cases to decrease agitation, decrease pain, and restore the patient's compatibility with the ventilator. RESULTS: A restoration of calm, a diminished amount of objective pain, a stability in measurable hemodynamics with improvement of the respiratory status. Early extubation is a priority. CONCLUSION: There is an urgent need to individualize postoperative treatment plans especially in the elderly, over the age of 60.