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The latest evidence for practice

Una Adderley
Senior Lecturer in Research Methods
Teeside University

Choice picks from the research journals, with
some choice comment...

Q: Does short-term use of opioids benefit older patients with chronic non-cancer pain?
As people grow older they are more likely to experience chronic pain due to conditions such as osteo-arthritis. Opioids are known to be effective analgesics but their safety, efficacy and abuse potential is unknown in the older population. This systematic review sought to explore these issues in the older population.

The review sought studies that had investigated transdermal or oral opioid interventions as a treatment for chronic pain that was not due to cancer in people over the age of 60. Studies were included if the average age of the study participants was over 60 years. Forty-three studies met the inclusion criteria and the data of these studies was combined and a meta-analysis conducted.

The systematic review found that 'young-old patients' (average age 60-73 years) with no other significant illnesses found short-term opioid treatment gave good but modest benefits in terms of physical functioning, sleep and quality of life. This age group were also less likely to abuse or misuse opioid drugs. However, older patients were more likely to experience side-effects of opioids, such as constipation and vomiting.

A commentary notes that although there are some weaknesses in the review, which might mean that some of the reported benefits may be overestimated, it is a well-designed study. The results are useful in addressing the concerns of clinicians regarding the effectiveness of opioid treatment for older patients.

Reference
Papaleontiou M, Henderson CR Jr, Turner BJ et al. Outcomes associated with opioid use in the treatment of chronic non cancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2010;58:1353-69.

Commentary
Haigh C. Evid-Based Nurs 2011;14(4):111.

Q: How can health visitors help prevent postnatal depression?
Postnatal depression is estimated to occur in around 13% of mothers and can have devastating effects for a young family. Effective interventions to identify, prevent and treat this condition are important in minimising risks and outcomes for those who may be affected.

This randomised, controlled trial sought to identify whether receiving care from a health visitor who had been trained to identify postnatal depression and offer psychological interventions prevented later depression in mothers who were not depressed six weeks after giving birth. A total of 101 primary care teams took part and were randomly allocated to one of two groups. The intervention group comprised health visitors who had been trained to offer cognitive behavioural therapy (CBT) and person-centred care. Those primary care teams in the comparator group included health visitors who had not been given this specific additional training. The outcome (postnatal depression) was measured using the Edinburgh Post-Natal Depression Scale at six, 12 and 18 months after giving birth. The health visitors involved in giving care were not informed of their clients' scores on this scale. The study found that there was a lower risk of postnatal depression at six months for those mothers who had received care from the primary care groups that had included health visitors training in CBT and person-centred care.

A commentary notes that there are some uncertainties around methods of randomisation and whether the positive effects of the intervention are due to the nature of the intervention or the number of contacts. However, it concluded that the study was sufficiently well designed for the results to be generalisable to the UK population. It recommends that since this study builds on previous research, consideration should be given as to how psychosocial interventions by healthcare professionals can be built into routine visits.

Reference
Brugha TS, Morrell CJ, Slade P et al. Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychol Med 2011;41:739-48.

Commentary
Leahy-Warren P, Corcoran P. Evid-Based Nurs 2011;14(4):128.