Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study

Abstract

Background Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. Methods The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI<2), mild (BPI 2–3.99), and moderate to severe (BPI 4–10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview. Results Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49% versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR=7.19, 95% CI 4.02–12.9). Nearly one-third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication. Conclusion Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.

Deficits in pain medication in older adults with chronic pain receiving home care: A cross-sectional study in Germany

“…This is important against the background of the history of chronic pain and intensity of current pain as observed during the last 24 hours in our cohort of patients. According to the MOBILIZE Boston study [33], about 30% of community-living older adults with moderate to severe pain were also inadequately treated, while 50% did not receive any pain medication [33]. The latter finding might be explained by the relative high ratio of patients with very mild to mild pain enrolled in this study [33].…”

“…According to the MOBILIZE Boston study [33], about 30% of community-living older adults with moderate to severe pain were also inadequately treated, while 50% did not receive any pain medication [33]. The latter finding might be explained by the relative high ratio of patients with very mild to mild pain enrolled in this study [33]. Roy et al reported in agreement with our current findings, that 16% of institutionalized elderly patients with pain did not receive treatment with analgesics [34].…”

“…One strength of our study is related to the fact that we included also patients with severe cognitive impairment (18.9%). This is in contrast to previous studies that either included only a very small number of these patients [21] or excluded patients with moderate to severe cognitive impairment [33] or dementia [45]. In order to assess the appropriateness of pain medication in the patients with severe cognitive impairment, we used a four-class categorization of the PAINAD-score to assess pain severity in this group of patients with a cutoff value of 1 for mild pain (S3 Table).…”

Factors influencing the efficacy of nonsteroidal anti-inflammatory drugs for acute low back pain. The results of the multicenter observational «CARAMBOL» (Clinical Analysis of Results of Analgesia by Meloxicam and its Safety in Acute Lumbodynia) study

“…Вероятно, у пациентов пожилого возраста чаще имеется структурная патология позвоночника (дегенеративные изменения позвонков и МПД, остеофиты, остеоартрит фасеточных суставов и др. ), что способствует хронизации воспаления и боли и снижает эффективность обезболивающих средств [18][19][20].…”

Nutraceutical-based Integrative Medicine: Adopting a Mediterranean Diet Pyramid for Attaining Healthy Ageing in Veterans with Disabilities

“…Inappropriate prescriptions [97][98][99][100] and potential prescription omissions [98] have also been documented. Moreover, multiple medications are frequently used in patients with PTSD and traumatic brain injury [101,102], as well as in the management of chronic pain [103][104][105][106].…”