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Inappropriate Rx for neuropathic pain common: among elderly.

NEW ORLEANS -- Elderly patients with a neuropathic disorder are much more likely to be prescribed an inappropriate pain medication than previously believed, said Dr. Bill McCarberg at the annual meeting of the American Academy of Family Physicians.

Half of 22,668 patients received at least one potentially inappropriate drug in 2000, based on an analysis of health care claims from a large insurance database. It was previously estimated that as many as 20% of all noninstitutionalized people aged 65 and older fit criteria for inappropriate drug use.

Using data containing records for roughly 3 million people in more than 20 states, the researchers compared diagnostic codes for painful neuropathic disorders with pharmacy claims for a list of drugs considered potentially inappropriate for patients aged 65 years and older, said Dr. McCarberg, director of Kaiser Permanente's chronic pain management program in San Diego.

The researchers looked at pain related to neuropathic disorders because these cases are typically difficult to treat, require multiple medications, and are very common in the elderly.

Specifically, the researchers included claims coded as diabetic neuropathy; postherpetic neuralgia; back and neck pain with neuropathic involvement; cancer with neuropathic involvement; causalgia, reflex sympathetic dystrophy, and related disorders; HIV/AIDS with neuropathic involvement; phantom limb pain; trigeminal neuralgia; atypical face pain; or other disorders of the peripheral nervous system associated with neuropathic pain.

The researchers used Beers" 1997 updated explicit criteria--an internationally recognized standard--to develop a list of medications that are considered potentially inappropriate in patients aged 65 and older. The drugs on this list often are not tolerated well or have special side effects in this population that can jeopardize health either directly (for example, prolonged sedation or blood pressure changes) or indirectly (increased drowsiness or confusion that could result in a fall).

The list of potentially inappropriate drugs included: propoxyphene, indomethacin, pentazocine, methocarbamol, carisoprodol, oxybutynin, chlorzoxazone, metaxalone, cyclobenzaprine, flurazepam, amitriptyline, doxepin, meprobamate, lorazepam, oxazepam, alprazolam, temazepam, zolpidem, triazolain, chlordiazepoxide, diazepam, hydroxyzine, promethazine, all barbiturates (except phenobarbital), and meperidine.

"There's an assumption that these drugs are safe and effective in this population. They certainly can be safe and effective but not necessarily in the elderly population. I don't think this message is getting out," Dr. McCarberg said.

Of the 50% of patients studied who were receiving more than one of these drugs, more than half were receiving propoxyphene and slightly less than half were receiving benzodiazepines.

Women were also more likely to have received one or more of these drugs than men--55% of women, compared with 43% of men. The use of these drugs also increased with age--48% of those aged 65-74 years, 52% of those aged 75-84 years, and 53% of those older than 84 years.

Rates of use were highest for patients diagnosed with postherpetic neuralgia (70%), phantom limb pain (60%), cancer with neuropathic involvement (55%), back and neck pain with neuropathic involvement (54%), causalgia (53%), and atypical face pain (50%).

The study was funded by Pfizer Inc.
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Title Annotation:Clinical Rounds
Author:Wachter, Kerri
Publication:Internal Medicine News
Geographic Code:1USA
Date:Feb 1, 2004
Previous Article:Patient education eases stress of chronic pain: targeted home-study materials.
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