Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents

Won, Aida B. MD
Lapane, Kate L. PhD
Vallow, Sue RPH, MBA
Schein, Jeff DrPH, MPH
Morris, John N. PhD
Lipsitz, Lewis A. MD

^*Hebrew Rehabilitation Center for Aged, Boston, Massachusetts
^†Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island
^‡Department of Community Health, Brown University Medical School, Providence, Rhode Island
^§Janssen Pharmaceutica, Inc., Titusville, New Jersey
^∥Gerontology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
^¶Division on Aging, Harvard Medical School, Boston, Massachusetts.

Address correspondence to Aida B. Won, MD, Hebrew Rehabilitation Center for Aged, 1200 Center Street, Boston, MA 02131. E-mail: [email protected] or [email protected]

This study was supported by a grant from Janssen Pharmaceutica Products LP to the Hebrew Rehabilitation Center for Aged and by Grants AG04390 and AG08812 from the National Institute on Aging, Bethesda, Maryland. Dr. Lipsitz holds the Irving and Edyth S. Usen and Family Chair in Geriatric Medicine, and Dr. Morris holds the Fred and Gilda Slifka Chair in Social Research at the Hebrew Rehabilitation Center for Aged. Sue Vallow and Jeff Schein are employees of Janssen Pharmaceutical Products LP. Drs. Won, Lapane, Morris, and Lipsitz do not have any financial relationships with Janssen Pharmaceutica Products LP.

This study was submitted and presented at the American Pain Society meeting, Chicago, Illinois, March 2003, and at the American Geriatrics Society meeting Baltimore, Maryland, May 2003.

(See editorial comments by Dr. Debra Weiner on pp 1020–1022)

Journal of the American Geriatrics Society 52(6):p 867-874, June 2004.

OBJECTIVES

To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain.

DESIGN

Cross-sectional study.

SETTING

Nursing homes from 10 U.S. states.

PARTICIPANTS

A total of 21,380 nursing home residents aged 65 and older with persistent pain.

MEASUREMENTS

Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes.

RESULTS

Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses.

CONCLUSION

In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain.