Falls Risk Assessment

Back to Review

Opioids

Drowsiness and sedation, dizziness, orthostatic hypotension, visual disturbance (infrequent) are some of the side effects experienced that can increase the risk of falls.1

Alternatives to consider to oral opioids:2

  • Regular paracetamol
  • Oral and/or topical NSAIDs
  • Lidocaine patches

Findings indicate comparability of transdermal buprenorphine and transdermal fentanyl for pain measures with significantly fewer adverse events caused by transdermal buprenorphine.3

If opioid is a must:

  • Dose reduction4
    • The opioid-induced side effects, such as drowsiness and delirium, are dose-dependent and can be minimized and sometimes eliminated by reducing the amount of administered medication.4
    • Start low and go slow when titrating down, only if pain is well controlled.5
    • Use the lowest dose possible to control the pain.4
    • Opioid doses greater than 50 morphine equivalents per day double the risk of fracture and falls1
  • Consider switching to prolonged release4,6
    • Chewing or crushing continuous release tablets destroys their controlled release properties and causes rapid absorption of the entire dose. This can result in overdose or increase in side effects experienced.
  • Opioid rotation4


    • A patient who has experienced adverse effects with several opioids within a given opioid class (eg, morphine, oxycodone, and hydromorphone, which are all phenanthrenes) might benefit from a trial of an opioid from a different opioid class (eg, fentanyl, which is a phenylpiperidine).5
    • Buprenorphine does not appear to have an increased risk of falls1
  • Altering route of administration4
    • Findings indicate comparability of transdermal buprenorphine and transdermal fentanyl for pain measures with significantly fewer adverse events caused by transdermal buprenorphine.3
    • Indications for initiating a trial of transdermal fentanyl in an opioid-tolerant patient include:
      • Intolerable side effects while on an oral opioid.

It is important to remember that use of a transdermal fentanyl patch should only be initiated for patients already taking opioids, not opioid naive patients.4


References

  1. Davis MP, Mehta Z. Opioids and chronic pain: where is the balance? Curr Oncol Rep. 2016;18(12):71.

  2. McGeeney BE. Pharmacological management of neuropathic pain in older adults: an update on peripherally and centrally acting agents. J Pain Symptom Manage. 2009;38(2):S15-S27. 

  3. Wolff RF, Aune D, Truyers C, Hernandez AV, Misso K, Riemsma R, et al. Systematic review of efficacy and safety of buprenorphine versus fentanyl or morphine in patients with chronic moderate to severe pain. Curr Med Res Opin. 2012;28(5):833-845. 

  4. Rogers E, Mehta S, Shengelia R, Reid MC. Four strategies for managing opioid-induced side effects in older adults. Clin Geriatr. 2013;21(4).

  5. Opioids O. Appropriate prescribing and education can help address opioid under usage for chronic pain in elderly patients. Dis Manag. 2006;22(9):7-11.

  6. Fine PG. Pharmacological management of persistent pain in older patients. Clin J Pain. 2004;20(4):220-226.

Back to Review