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The effects of opioids on cognition in older adults with cancer and chronic non-cancer pain: A systematic review

Pask, Sophie; Dell’Olio, Myriam; Murtagh, Fliss E.M.; Boland, Jason W.


Sophie Pask

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Dr Jason Boland
Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine



Opioids are prescribed to manage moderate to severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment.

To identify, appraise and synthesise evidence on i) the impact of opioids on cognition in older adults with cancer/chronic non-cancer pain, and ii) screening tools/neuropsychological assessments used to detect opioid-induced cognitive impairment.

A systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PROSPERO Registration CRD42018092943). MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and Web of Science were searched up to December 2018. Randomised controlled trials, quasi-experimental studies and observational studies of adults aged ≥65 with cancer/chronic non-cancer pain taking opioids were included. A narrative synthesis was conducted.

From 4,036 records, 10 met inclusion criteria. Five studies used one screening tool and five used a range of neuropsychological assessments; assessing 14 cognitive domains. Most studies demonstrated no effect of opioid use on cognitive domains, whilst four studies showed mixed effects. In particular, attention, language, orientation, psychomotor function and verbal working/delayed episodic memory were worsened. Changes to cognitive function were predominantly observed in studies with higher mean doses of opioids (120mg–190.7mg oral morphine equivalent daily dose).

Both improvements and impairments to cognition were observed in studies with higher mean opioid doses. In clinical practice, a brief screening tool assessing attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory, may be beneficial to detect worsening cognition in older adults with chronic pain using opioids.


Pask, S., Dell’Olio, M., Murtagh, F. E., & Boland, J. W. (2020). The effects of opioids on cognition in older adults with cancer and chronic non-cancer pain: A systematic review. Journal of pain and symptom management, 59(4), 871-893.

Journal Article Type Review
Acceptance Date Oct 21, 2019
Online Publication Date Oct 31, 2019
Publication Date Apr 1, 2020
Deposit Date Nov 4, 2019
Publicly Available Date Nov 1, 2020
Journal Journal of Pain and Symptom Management
Print ISSN 0885-3924
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 59
Issue 4
Pages 871-893
Keywords Opioids; Cognition; Cancer; Chronic pain; Pain; Elderly; Systematic review
Public URL
Publisher URL
Contract Date Nov 4, 2019


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