Adding serotonin and norepinephrine reuptake inhibitors (SNRIs) to short-acting opioids for nonmalignant pain in nursing home residents doesn’t seem to boost their risk for delirium compared with giving them nonsteroidal anti-inflammatory drugs (NSAIDs), according to study results published in the Journal of the American Geriatrics Society.
Non-malignant pain is described as pain that continues for at least three months.
The data came from national sources that covered nursing home residents from 2011 through 2016. The researchers also looked at Medicare claims data. Most of the study participants were non-Hispanic white women who were aged 75 or more years.
The data included details on nursing home residents who took short-acting opioids and either started on an SNRI or an NSAID.
Of the people studied, 5,350 of them took SNRIs, and the same number took NSAIDs (along with the short-term opioids). A total of 48% of the people were taking hydrocodone, which was the most popular short-acting opioid given. Other common short-term opioids include morphine or hydromorphone. Commonly used NSAIDs include aspirin, ibuprofen and naproxen.
During the span of one year, 10.8% of people on SNRIs developed delirium. And 8.9% experienced it when they took NSAIDs.
In short, among nursing home residents, adding SNRIs to short-acting opioids does not seem to boost the risk for delirium compared with taking NSAIDs.
“Understanding the comparative safety of pain regimens is needed to inform clinical decisions in a medically complex population often excluded from clinical research,” the authors stated.
Delirium can accompany 60% of the acute illnesses and adverse health events that occur commonly among nursing home residents, according to research from 2021. But the study team said it is not always easy to spot. The condition can change a person’s attention span, cognition and consciousness. It can shift during the day and can emerge over a short period of time. Generally, delirium lasts only temporarily.
