Clinical Interventions in Aging (Aug 2015)
Is oxycodone/naloxone effective and safe in managing chronic pain of a fragile elderly patient with multiple skin ulcers of the lower limbs? A case report
Abstract
Fabio Guerriero,1,2 Niccolo Maurizi,1 Matthew Francis,1 Carmelo Sgarlata,1 Giovanni Ricevuti,1,2 Mariangela Rondanelli,2,3 Simone Perna,2,3 Marco Rollone21Department of Internal Medicine and Medical Therapy, Section of Geriatrics, University of Pavia, 2Azienda di Servizi alla Persona, Istituto di Cura Santa Margherita of Pavia, 3Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Pavia, Italy Abstract: Skin ulcers are a common issue in the elderly, as physiological loss of skin elasticity, alterations in microcirculation, and concomitant chronic diseases typically occur in advanced age, thereby predisposing to these painful lesions. Wound-related pain is often associated with skin ulcers and negatively impacts both the patient’s quality of life and, indirectly, wound healing. Pain management is an ongoing issue in the elderly, and remains underestimated and undertreated in this fragile population. Recent guidelines suggest the use of opioids as the frontline treatment of moderate and severe pain in nononcological pain in the elderly. However, due to the concerns of adverse reactions, drug interactions, and addiction, clinicians frequently hesitate to prescribe opioids. This case report describes an elderly diabetic patient with multiple ulcers of the lower limbs suffering wound-related pain. In our report, oxycodone/naloxone has proved to be an effective and safe drug, providing pain relief as well as increased compliance when redressing wounds and faster healing compared to that in similar patients. Our case provides anecdotal evidence, supported by other studies, to justify future, larger studies on chronic pain using this therapy. Keywords: chronic pain, skin ulcers, elderly, opioids, oxycodone, naloxone
