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

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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.

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Acknowledgements

This work was supported by the National Institute on Aging Grant R01AG041525; NIA Research Nursing Home Program Project Grant P01AG004390; an unrestricted Grant from Pfizer, Inc. to support medication data coding. Ms. Nawai’s effort was supported by a Royal Thai Government Scholarship.

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Authors and Affiliations

  1. College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA

    Ampicha Nawai, Suzanne G. Leveille & Guusje van der Leeuw

  2. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Suzanne G. Leveille & Robert H. Shmerling

  3. Harvard Medical School, Boston, MA, USA

    Suzanne G. Leveille, Robert H. Shmerling & Jonathan F. Bean

  4. New England Geriatric, Research, Education and Clinical Center, Boston Veterans Administration Health System, Boston, MA, USA

    Jonathan F. Bean

  5. Spaulding Rehabilitation Hospital, Boston, MA, USA

    Jonathan F. Bean

Authors
  1. Ampicha Nawai
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  2. Suzanne G. Leveille
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  3. Robert H. Shmerling
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  4. Guusje van der Leeuw
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  5. Jonathan F. Bean
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Corresponding author

Correspondence to Ampicha Nawai.

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Conflict of interest

The authors report no conflicts of interest.

Role of the sponsors

The sponsors were not involved in the data collection, analysis, interpretation of the findings, or in the preparation of this manuscript.

Statement of human and animal rights

The Mobilize Boston Study was approved by the Institutional Review Boards of Hebrew SeniorLife and the collaborating institutions in Boston, including Harvard Medical School, Beth Israel Deaconess Medical Center, Boston University, and the University of Massachusetts Boston (UMASS).

Informed consent

Participants who were eligible to participate in the Mobilize Boston Study were obtained using informed consent during the baseline home visits.

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Nawai, A., Leveille, S.G., Shmerling, R.H. et al. Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study. Aging Clin Exp Res 29, 1139–1147 (2017). https://doi.org/10.1007/s40520-016-0700-9

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  • DOI: https://doi.org/10.1007/s40520-016-0700-9

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