Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

Kate L Lapane,Bill M Jesdale,Anne L Hume,Reynolds A Morrison

doi:10.1007/s00228-020-02878-0

Abstract

ObjectiveWe estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity.MethodsMedicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis.ResultsOf these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those ≥ 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common.ConclusionAmong nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist.

Highlights

Keypoints Nursing home residents commonly experience pain. Medication management of pain could be improved as one in four residents in severe pain received no pain medications or adjuvants to pain medications.Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.In the USA, there are ~ 1.7 million certified nursing home beds [1]
Using a national database of nursing home residents (2011–2016), this study aimed to provide a contemporary description of prescription analgesic and adjuvant use by pain severity among nursing home residents, to estimate the prevalence of lack of prescription analgesic use across levels of pain severity, and to identify factors associated with lack of prescription analgesics and/or adjuvants for residents with reported pain
Among the 25.6% reporting severe pain, 3.5% reported their pain frequency as rarely, 28.7% as occasionally, 44.0% as frequently, and 22.9% as almost constantly, with 42.4% reporting that pain affects sleep and 52.8% indicating that pain limits day-to-day activities

Summary

Introduction

Keypoints Nursing home residents commonly experience pain. Medication management of pain could be improved as one in four residents in severe pain received no pain medications or adjuvants to pain medications. In the USA, there are ~ 1.7 million certified nursing home beds [1]. For the residents who live in this healthcare setting, pain is a common occurrence [2, 3]. Pain may be associated with complications such as depression, decreased social engagement, increased healthcare utilization and costs, increased functional limitations, and poor treatment outcomes [4,5,6]. The effective management of pain is key to improving or maintaining the quality of life of older adults

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Results

Discussion

Conclusion