Tuesday, June 1, 2010

Older Patients Denied Adequate Pain Relief

Conference NotesPersons older than 65 years of age are less likely to receive strong analgesics for moderate to severe pain than younger patients complaining of comparable pain, according to researchers at the 2010 Annual Meeting of the American Geriatrics Society (AGS). Specific reasons for this are as yet undetermined.

A nationwide study found that strong-opioid therapy was prescribed to 36% of patients aged younger than 65 years, compared with 31% of patients aged 65 to 74 years and 25% of patients 75 years of age or older. Investigator Aarti Patel, PharmD, said during a poster presentation on May 13, 2010, "Results from [a] large national survey suggest that inadequate analgesia and undertreatment of pain are common, particularly among older patients." The survey included responses from nearly 57,000 patients being treated for pain post surgery, osteoarthritis flares, trauma or injury, acute low back pain, acute neck pain, acute shingles, or another acute condition. In each age group about 95% of the patients indicated they were suffering from moderate to severe pain due to the various conditions. Overall, "we observed that the older the patient was, the less likely it was that the patient would receive adequate pain relief," Patel noted. She further said that researchers are now trying to determine the reasons for the under-prescribing of adequate pain relief in the elderly.

COMMENT: In the above study, which was funded by Ortho-McNeil Janssen Scientific Affairs, the greatest absolute risk difference was 11% (36% minus 25%), which may not seem enormous but could account for millions of undertreated elderly persons on a national scale. The American population aged 65 years or older numbered 37 million in 2006 and it is expected to nearly double by 2030. It is well known that poorly controlled pain in older patients can negatively affect quality of life, resulting in depression, sleep disturbance, social isolation, cognitive impairment, and other detriments. At the same time, there have been concerns about strong analgesics incurring greater adverse events in the elderly, so achieving a balance of risks-benefits can be challenging. For the most current guidelines from the AGS on the “Pharmacological Management of Persistent Pain in Older Persons” [click here].

SOURCE:AGS presentation title: The Undertreatment of Moderate to Severe Pain Among Elder and Non-Elderly Patients; Abstract A99. Reported in Doctor’s Guide, May 14, 2010 [available here].