The PRISCUS list was set out on the basis of international examples of similar lists that were checked and added to by selected experts from the German speaking countries. For the topic of pain management, the list requires several corrections. The following is a selection of these.
- The association of pethidine with an increased risk of fractures is likely to be based on a misunderstanding from an epidemiological study from Denmark (1). The authors actually describe an increased risk of fractures in patients taking codeine, fentanyl, morphine, methadone, oxycodone, and tramadol; this effect was not confirmed for buprenorphine, pethidine, and a combination of ASA with codeine.
- In pain therapy, anticonvulsants and antidepressants are used in low dosages, on the basis of many clinical studies. This indication was not taken into consideration in the article.
- The association of etoricoxib with an increased risk of heart failure comes from a post hoc analysis of the MEDAL study (2). In their analysis, the authors found an increased risk compared with diclofenac in elderly patients only for the high dosage of 90 mg/d. This association has not been shown for the usual dosage of 60 mg/d. Rather, Fosbøl et al. assessed the risk of diclofenac and coxibs as the same (3).
From a pain therapeutic point of view, we therefore have grave objections to the undifferentiated adoption of the recommendations from the PRICUS list. We recommend using this list only with the note that the recommendations do not apply to patients with an indication for pain therapy.
Dr. med. Markus Gehling
34125 Kassel, Germany
Conflict of interest statement
The author reports links to MSD, mundipharma, sanofi aventis, and Metronic.
|1.||Vestergaard P, Rejnmark L, Mosekilde L: Fracture risk associated with the use of morphine and opiates. J Int Med 2006; 260: 76–87. MEDLINE|
|2.||Krum H, Curtis SP, Kaur A, et al.: Baseline factors associated with congestive heart failure in patients receiving etoricoxib or diclofenac. Eur J Heart Failure 2009; 11: 542–50. MEDLINE|
|3.||Fosbøl EL, Folke F, Jacobsen S, et al.: Cause-specific cardiovascular risk associated with nonsteroidal antiinflammatory drugs among healthy individuals. Circ Cardiovasc Qual Outcomes 2010; 3: 395–405. MEDLINE|
|4.||Holt S, Schmiedl S, Thürmann PA: Potentially inappropriate medications in the elderly: The PRISCUS List. Dtsch Arztebl Int 2010; 107 (31–32): 543–51.|