Improving the Pharmacologic Management of Pain in Older Adults: Identifying the Research Gaps and Methods to Address Them

Abstract

Objective There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an “Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults” conference in September, 2010, to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and non-steroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. Design Eighteen panel members provided oral presentations; each was followed by a multidisciplinary panel discussion. Meeting transcripts and panelists’ slide presentations were reviewed to identify the gaps, and the types of studies and research methods panelists suggested could best address them. Results Fifteen gaps were identified in the areas of treatment(e.g., uncertainty regarding the long-term safety and efficacy of commonly prescribed analgesics), epidemiology (e.g., lack of knowledge regarding the course of common pain syndromes), and implementation(e.g., limited understanding of optimal strategies to translate evidence-based pain treatments into practice). Analyses of data from electronic health care databases, observational cohort studies, and ongoing cohort studies (augmented with pain and other relevant outcomes measures) were felt to be practical methods for building an age-appropriate evidence base to improve the pharmacologic management of pain in later life. Conclusions Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well being of older adults with chronic pain.

Pain severity, interference, and prescription analgesic use among depressed, low-income homebound older adults

“…Second, better pharmacologic management, including clinical evaluation, follow-up, and attention to potential toxicities of pharmacotherapy, is needed for analgesic users, especially given the multiple medications that these adults take for their medical and mental health conditions. Continued uncertainties regarding the risks and benefits and the long-term safety and efficacy of commonly prescribed analgesics and potential opioid-induced hyperalgesia also require careful attention to analgesic use (Brush, 2012;Reid et al, 2011). Health care providers also need to examine possible unsupervised use of OTC pain relievers among both users and nonusers of prescription analgesics.…”

Nonsteroidal anti-inflammatory drugs (NSAIDs) in older people: Prescribing patterns according to pain prevalence and adherence to clinical guidelines

“…Moreover, rational prescribing of opioid analgesics in older people remains challenging due to potential risk of adverse effects [28]. Studies are required to elucidate the impact of multiple concomitant medications among NSAIDs users, in particular contribution to adverse effects, response to analgesic treatment and the impact on the overall pain management [35].…”

Prescription Opioid Medications: Efficacy in Chronic Pain

“…Among those with no history of past psychopathology, they also found association between lifetime nonmedical prescription opioid use and incident depressive, bipolar and anxiety disorder [54].…”