Background & Aims
Chronic pain affects up to 39% of older adults [9; 14]. It is associated with frailty, mobility limitations, cognitive impairment, and decrements in quality of [QOL; 3; 5; 12]. Although effective chronic pain management is critical for older adults, only limited data are available on the use of pharmacologic and nonpharmacologic approaches for pain management in this population. Moreover, the use of opioids for chronic pain management has received significant scrutiny in recent years. While opioids became less accessible, access to nonopioid treatments is limited for many older adults, because therapies are not affordable, not recommended by clinicians, or not available in their community [2; 8; 10; 15; 16]. To elucidate the pain management strategies used by older adults, the goal of these analyses was to examine the use of pharmacologic and non-pharmacologic pain treatments among a nationally representative sample of older adults in the United States (U.S.).
Methods
A sample of 1,296 older adults (aged ?65) with chronic pain was recruited from NORC at the University of Chicago’s AmeriSpeak® Panel. The AmeriSpeak Panel is a probability-based panel that uses state-of-the-art approaches to provide ?97% sample coverage of the U.S. population. To ensure that even hard-to-reach populations are represented, recruitment involves an extensive non-response follow-up program that includes enhanced respondent incentives and in-person, face-to-face recruitment by professional field interviewers. To assess use of pharmacologic and nonpharmacologic pain management strategies, participants were asked to indicate which interventions they used to manage pain during the past 3 months. Using SAS 9.4 (SAS Institute, Inc, Cary, NC), nationally representative estimates of the prevalence of each pain management strategy were generated by incorporating the survey design weights.
Results
Thirty percent (95% CI: 26.7-33.1) of U.S. older adults with chronic pain reported using prescription opioids and 86.6% (95% CI: 84.3-89.0) reported using over-the-counter (OTC) pain relievers. Moreover, nearly one-in-five (95% CI: 16.7-22.3) reported using cannabidiol and one-in-ten (95% CI: 8.6-12.8) reported using cannabis or tetrahydrocannabinol. The most common nonpharmacologic pain management approaches were physical, rehabilitative, or occupational therapy (30.7%, 95% CI: 27.6-33.8), massage (29.1%, 95% CI: 26.0-32.1), and meditation, guided imagery, or relaxation (28.5%, 95% CI: 25.4-31.6). Chiropractic care (15.0%, 95% CI: 12.7-17.3) and yoga (12.0%, 95% CI: 9.8-14.2) were frequently used. Only 4.4% (95% CI: 2.7-6.0) of older adults used talk therapies (e.g., cognitive behavioral therapy) for pain management. Similarly low rates were observed for use of pain self-management programs (7.1%, 95% CI: 5.4-8.7) and peer support groups (1.5%, 95% CI: 0.7-2.2).
Conclusions
Although judicious use of opioid analgesics for the management of pain in older adults is recommended, almost a third of U.S. older adults with chronic pain were prescribed opioids for pain management. A clear and urgent need exists to elucidate the risks and benefits of using opioids in this extremely high-risk population. Other pharmacologic treatments, including OTC pain medications and cannabis were also commonly used in this sample. However, despite an established body of evidence supporting the efficacy of behavioral pain management strategies, talk therapies, pain self-management programs, and peer support groups were rarely used. Additional research is needed to identify barriers to engaging in nonpharmacologic pain treatment (including behavioral pain management approaches) and to develop strategies that increase access to these modalities. Future work should also clarify the impact of different pain management strategies on key patient-reported outcomes in older adults.
References
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Presenting Author
Christine Ritchie
Poster Authors
Topics
- Access to Care