Pain Treatment of Underserved Older African Americans

Abstract

Older adult African Americans who experience pain are especially at high-risk for under assessment and treatment. This study examined the patterns and correlates of pain medication use that include the following: severity of pain, medical conditions, and access to care. Four hundred African American older adults aged 65 years and older were recruited from 16 churches located in South Los Angeles. Structured face-to-face interviews and visual inspection of each participant’s medications were conducted. More than 39% of participants were 75 years and older and 65% were female. Forty-seven percent used at least one type of pain medication. The frequency of pain medication use by pharmaceutical class was as follows: non-opioid (33%), opioid (12%), adjuvant (9%), and other drug (8%). Furthermore, 77% of non-opioids were Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and were used among 25%, 28%, 26%, and 28% of participants with hypertension, stroke, kidney disease, and gastrointestinal problems, respectively. Among participants who used NSAIDs, 98%, 69%, and 65% experienced Potentially Inappropriate Medication (PIM) use, drug duplication, and drug-drug interactions, correspondingly. This study suggests a severe mismanagement of pain among underserved African American older adults, particularly among individuals with co-morbidity, multiple providers, and limited access to health care. The use of pain medication was associated with drug-drug interactions, drug duplication, and PIM use. Our data shows that a large number of participants with severe pain are either not taking pain medication or experience PIM use. One out of four participants was taking NSAID pain relievers, which can cause serious side effects among aged African Americans with multiple chronic conditions.

Mental and Physical Health Correlates of Financial Difficulties Among African-American Older Adults in Low-Income Areas of Los Angeles

“…This aligns with much of the existing research which has shown that low SES is related to higher risk for incidence of pain, greater severity of pain, as well as, greater disability and distress from pain (18)(19)(20)(21)(22). While the previous research demonstrated the relationship between financial difficulties and several aspects of pain, the current study shows this relationship holds for AA samples specifically, who are especially at risk for pain mismanagement or undertreatment (71)(72)(73)(74).…”

<p>Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria</p>

“…In those studies, the most frequent PIMs were represented by PPIs, drugs without an indication, NSAIDs, and benzodiazepines, whereas PPOs were represented by statins, antiplatelet agents, calcium, and vitamin D. [24][25][26][27] The most prevalent PIMs observed in our study are in accordance with those from other studies. [28][29][30][31][32] A study in Romania by Primejdie et al in 2016 using the STOPP/ START criteria of 2008 showed that the drug class with the highest percentage of use was NSAIDs (56.66% of outpatients and 35.63% of hospitalized patients), followed by benzodiazepines. That study did not assess PPOs.…”

Chronic pain, cardiovascular health and related medication use in ageing African Americans with osteoarthritis

“…Thus, it is not surprising that there was a high prevalence of NSAID consumption by participants, especially in those with HTN. Given that OTC NSAIDs are more accessible (Booker, Herr, et al, 2019), NSAIDs are commonly used by African Americans in later life (Yazdanshenas et al., 2016). The second potential biological–behavioural syndemic is that of chronic pain‐HTN and NSAID use in African American, which could be fuelled by lack of access to prescription medication, inadequate knowledge drug–disease interaction and fear of addiction of opioids (Booker, Herr, et al, 2019; Park, Manotas, & Hooyman, 2013).…”