University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Emergency Medicine


Dr. Nancy Reid



Purpose: The purpose of this article is to review the current guidelines and alternative regimens of treatment for acute-on-chronic non-cancer pain management in the emergency room of patients, aged 65 and older, taking chronic opioid medications.

Methods: A PubMed, Clinician Review, and Uptodate© literature search was conducted with search terms: Elderly, Chronic pain, Opioids, Opioid epidemic, Emergency room, Elderly, Non-opioid medication, Efficacy, NSAIDs, and Homeopathy. Several pertinent articles were retrieved, and they serve as the basis for this clinical review.

Results: There is a significant lack of evidence-based research to show an equally effective treatment, apart from opioids, for acute-on-chronic pain in the elderly (whom are already taking opioids) in the emergent setting.

Conclusion: Opioid medications have long been used in emergency medicine to quickly and effectively treat acute pain. Research has shown that opioids have significant side effects and adverse outcomes in the elderly population. There is little evidence-based research comparing opioid utilization to alternative regimens for acute-on-chronic pain in the elderly. The research available does support the reduction of opioid utilization in the emergent setting for elderly patients; however, there has been no movement to decrease this pattern, and very little research has been conducted to show the effectiveness of non-opioid medication for acute-on-chronic conditions in patients already taking opioids. Further research is needed to find rapid and effective treatment for acute-on-chronic pain in the elderly in the emergency setting.

Keywords: Opioids, Non-Opioids, Elderly, Acute-on-chronic pain, Emergency Medicine.


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