Prevalence Of Analgesic Use Research Articles

Analgesic use among residents of youth sociotherapy centres and youth correctional centres

Introduction and aim: International and national studies indicate that analgesic use is common among adolescents. Research projects on this issue in Poland to date have been conducted among youth attending mainstream schools. However, data on the analgesic use among adolescents attending special education institutions, i.e. youth sociotherapy centres (młodzieżowe ośrodki socjoterapii, MOS) and youth correctional centres (młodzieżowe ośrodki wychowawcze, MOW) is missing. The aim of this study was to assess the prevalence of analgesic use among youth attending special education centres. Materials and methods: The study was conducted in 2018 among youth aged 12–19 years from randomly selected MOS/MOW facilities in Poland (N = 1,730). Data was collected with a self-administered questionnaire. A chi-square test was used to assess differences in analgesic consumption rate by gender and facility type. Results: Approximately 60% and 44.5% of study participants used analgesics for headache and stomach-ache, respectively, at least 1–2 times in the past month. Girls are significantly more likely than boys to use medications for headache and stomach-ache. The analgesic consumption rate among MOS/MOW youth is higher than among adolescents attending mainstream schools. Conclusions: Due to the risk associated with medicine use preventive measures addressing youth should include activities aimed at improving knowledge and skills regarding safe medication use. A history of analgesic use by an adolescent should be part of a family doctor’s routine interview.

Prevalence of sport-relatedanalgesic use in German elite handball Players

With its high physical demands on players’ bodies and high rates of injury, elite-level handball constitutes an ideal environment for studying analgesic use. We aimed to investigate the career and season prevalence of sport-related analgesics use among elite youth and elite senior handball players. We explored the frequency of analgesic use on practice and competition days within one season. The sample consisted of 459 elite handball players (233 female, 226 male). Sport-related analgesic use was assessed with two replicable measures of prevalence complemented by two frequency measures. χ2 analyses were performed to determine group differences in prevalences for gender, age group, contract situation, and role within the team. We conducted hierarchical binomial linear regression analyses for the analgesic prevalences to evaluate the prediction of the prevalences from the independent variables. The sport-related career prevalence of analgesic use was 70.7% (95% CI[66.6, 74.9]). Throughout one season, 55.6% (95% CI[51.0-60.1]) of handball players used analgesics. Gender, age, contract status, and role within the team seemed to impact the use of analgesics. Further, analgesics were used significantly more often on competition than on practice days. Our findings indicate that the sport-related use of analgesics is relatively common among elite handball players, with female players, senior players, players with a contract, and perceived rotation players reporting significantly higher career and season prevalences. Therewith, our findings offer a starting point for targeted prevention strategies.

MO485PREVALENCE OF ANALGESICS USE AND ASSOCIATED ADVERSE OUTCOMES IN THE CHRONIC KIDNEY DISEASE POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS*

Abstract Background and Aims Pain is one of the commonest symptoms in patients with chronic kidney disease (CKD), with a large proportion undertreated. Managing chronic pain in CKD patients is problematic due to the altered pharmacokinetic and pharmacodynamic related to the reduced renal clearance making it challenging for physicians to find appropriate pain management strategies. The aim of this systematic review was to estimate the overall prevalence of different types of analgesia in patients with CKD and investigate their safety. Method The population comprised of all adult patients with CKD defined as an estimated glomerular filtration rate (eGFR) less than 60mL/min/1.73m2 which included CKD-non dialysis (CKD-ND), kidney transplant recipients (KTR), patients undergoing dialysis and those receiving palliative care. Analgesics investigated included opioids, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), gabapentinoids and acetaminophen. All studies reporting a prevalence of analgesic use and/or exploring the association between analgesic consumption and adverse outcomes were included. Medline, Embase, CENTRAL, CINAHL and the grey literature were searched up to December 2020. Random-effect meta-analyses were conducted using a Generalised Linear Mixed Model approach to estimate the overall prevalence of analgesics use in the CKD population, displayed in forest-plots. Evidence gathered from studies investigating the adverse outcomes related to analgesics consumption was synthesised in ‘harvest plots’. Results Sixty-three studies reporting a prevalence of analgesic use in patients with CKD were included. The overall prevalence of analgesic consumption was 42% (95% CI, 35-50%) in the general CKD population and 70% (95% CI, 62-68%) among those experiencing chronic pain. Seventeen studies reported a prevalence of opioid use with 36% (95% CI, 23-51%) of patients with CKD receiving at least one opioid prescription while 16% (95% CI, 11-22%) were on chronic opioid therapy. The chronic use of oxycodone, tramadol, propoxyphene, fentanyl and hydromorphone were 3.6%, 2.0%, 1.3%, 1.1% and 0.05% respectively. NSAIDs usage was estimated to 20% (95% CI, 15-25%) among patients with CKD (ibuprofen 4.6%, diclofenac 1.7%) and 8% (95% CI, 5-12%) took NSAIDs chronically, with a higher prevalence among dialysis patients (17%) compared with CKD-ND (7%) and KTR (5%) (p<0.01). Prevalence of gabapentin and pregabalin use was estimated at 10% and 3.5% respectively, on pooling of 3 studies. Finally, five studies yielded an overall prevalence of 24% for acetaminophen use. Twenty studies assessing the association between analgesic use and adverse outcomes were included (Figure 1). Five of them demonstrated an association between opioid use and increased mortality, in all CKD subgroups; and three out of four studies reported more hospitalizations in opioid-users.Four studies highlighted an increased risk of gastro-intestinal bleeding associated with NSAIDs consumption and three studies found a significant association between gabapentin use and neurologic adverse events. Conclusion Only 70% of CKD patients experiencing chronic pain received an analgesic, suggesting that pain remains a significant public health burden. Despite limited evidence, opioids, NSAIDs and gabapentinoids seem to be associated with major adverse events. Their use requires cautious prescription, consideration of optimal dosage, and the development of therapeutic patient education to promote risk awareness. More evidence is warranted to better understand the adverse outcomes associated with long-term analgesic consumption and provide safe pain management strategies for patient with CKD.

Ten-year trend of opioid and nonopioid analgesic use in the French adult population.

Analgesics are the most widely used medicines worldwide. In parallel, opioid abuse has increased and is of major concern. The accessibility of pharmacologically powerful medicines and the addictovigilance signals in France about the risk of opiates addiction call for an overview of analgesic use. The objective of this study was to investigate the use of analgesics reimbursed in France over a 10-year period through its prevalence. A cross-sectional study repeated yearly was conducted by using data from the French reimbursement database from 2006 to 2015. Analgesics were classified according to their pharmacological potency: prevalence of use for each category and sociodemographic characteristics of patients treated were analysed. The annual prevalence of analgesic use was high and increased during the study period (59.8%, 253 976 users in 2015). In 2015, prevalence was always higher in women and increased with age, except for those older than 84 years. Peripheral analgesics were the most used (55.3%, 234 739 users). The prevalence of weak analgesic use decreased (21.3%, 90 257 users), mainly due to the definitive withdrawal of dextropropoxyphene in France in 2011, which was not offset by an increase in the consumption of other weak analgesics. For strong analgesics (1.2%, 5129 users), morphine was the most widely used, with a dramatic increase in oxycodone use, especially in the elderly. The prevalence of analgesic use is high: approximately 31 million adults had at least 1 analgesic reimbursed in 2015. The most widely used analgesics were peripheral analgesics, far ahead of opioid analgesics.

Analgesic Use in Patients With Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis.

Background:Pain is common in patients with chronic kidney disease (CKD). Analgesics may be appropriate for some CKD patients.Objectives:To determine the prevalence of overall analgesic use and the use of different types of analgesics including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvants, and opioids in patients with CKD.Design:Systematic review and meta-analysis.Setting:Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity.Patients:Adults with stage 3-5 CKD including dialysis patients and those managed conservatively without dialysis.Measurements:Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of analgesic use, and the types of analgesics prescribed.Methods:Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of analgesic use and the I2 statistic was computed to measure heterogeneity. Random-effects models were used to account for variations in study design and sample populations, and a double arcsine transformation of the prevalence variables was used to accommodate potential overweighting of studies with very large or very small prevalence measurements. Sensitivity analyses were performed to determine the magnitude of publication bias and assess possible sources of heterogeneity.Results:Forty studies were included in the analysis. The prevalence of overall analgesic use in the random-effects model was 50.8%. The prevalence of acetaminophen, NSAIDs, and adjuvant use was 27.5%, 17.2%, and 23.4%, respectively, while the prevalence of opioid use was 23.8%. Due to the possibility of publication bias, the actual prevalence of acetaminophen use in patients with advanced CKD may be substantially lower than this meta-analysis indicates. A trim-and-fill analysis decreased the pooled prevalence estimate of acetaminophen use to 5.4%. The prevalence rate for opioid use was highly influenced by 2 large US studies. When these were removed, the estimated prevalence decreased to 17.3%.Limitations:There was a lack of detailed information regarding the analgesic regimen (such as specific analgesics used within each class and inconsistent accounting for patients on multiple drugs and the use of over-the-counter analgesics such as acetaminophen and NSAIDs), patient characteristics, type of pain being treated, and the outcomes of treatment. Data on adjuvant use were very limited. These results, therefore, must be interpreted with caution.Conclusions:There was tremendous variability in the prescribing patterns of both nonopioid and opioid analgesics within and between countries suggesting widespread uncertainty about the optimal pharmacological approach to treating pain. Further research that incorporates robust reporting of analgesic regimens and links prescribing patterns to clinical outcomes is needed to guide optimal clinical practice.

Prevalence of analgesic use in patients with chronic pain referred to a multidisciplinary pain centre and its correlation with patient-reported outcome measures: A cross-sectional, registry-based study.

Chronic pain is prevalent in Sweden, nearing 20% in the adult population. Treatment often requires a multimodal approach, with medication, physical therapy and psychological interventions. However, the frequency of medication in patients with chronic pain in Sweden, and its correlation with patient-reported outcome measures (PROMs), are currently unknown. To investigate the frequency of use of analgesics and other medication in patients with chro-nic pain referred to a multidisciplinary pain centre, and how opioid treatment relates to PROMs. Cross-sectional, registry-based study. New referral visits (n = 1,275) to the Pain and Rehabilitation Center in Linköping, Sweden in 2015. 441 patients had complete medication and PROM data. Patient-reported analgesic and other medications were matched with patient PROM data from the Swedish Quality Registry for Pain Rehabilitation. Univariate analysis was conducted with IBM Statistical Package for the Social Sciences (SPSS; IBM Corporation, Somers, NY, USA) version 24.0, and multivariate analysis with SIMCA-P+ (version 13, Umetrics AB, Umeå, Sweden), with a special emphasis on opioids. n = 132 (30%) patients used opioids daily, and this group differed from other patients on many PROMs, with medium effect sizes for pain severity, interference, health-related quality of life, activity engagement, and satisfaction with social life. Multivariate analysis identified four groups and showed that daily use of opioids was significantly correlated with high pain intensity and low physical functioning. Prevalence of daily opioid use was 30% and daily opioid use did not correlate with better outcome of PROMs. Longitudinal studies are warranted (e.g. on the clinical effect of tapering), as are studies that can better explain the medication variability in patients with complex chronic pain.

Analgesic use among the Brazilian population: Results from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM).

PurposeTo estimate the prevalence of use of analgesics in Brazil; and to characterize this use, according to sociodemographic and health-related characteristics.MethodsA cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines, PNAUM) was conducted between September 2013 and February 2014. A total of 41,433 people of all ages in Brazilian urban households were interviewed. Occasional use (within the last 15 days) and continuous use of non-opioid analgesics, opioid analgesics and non-steroidal anti-inflammatory drugs were investigated, regardless of whether this use occurred through prescription or self-medication. The main outcome was the use of at least one analgesic.ResultsThe majority of the individuals were female (52.8%), aged between 20 and 59 years (57.2%), with 1 to 8 years of schooling (45.6%). The overall prevalence of analgesic use was 22.8% [95% CI: 21.4–24.2]. The use of analgesics was significantly higher among women, adults and elderly (20 years or more), highly educated individuals and respondents who referred: diagnosis of one or more chronic diseases, using three or more medications, possession of health insurance and with one or more emergency care admittances or hospitalizations within the last year. Non-opioid analgesics were the agents most used (18.5% of the sample), followed by non-steroidal anti-inflammatory drugs (6.9%) and opioid analgesics (0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics), paracetamol (25.3%) and diclofenac (10.7%). These drugs were used mainly to manage occasional health conditions, particularly pain.ConclusionOne in five Brazilians used some analgesic, especially non-opioid analgesics, to manage acute health problems such as painful conditions.

Prevalence of chronic postsurgical pain after thoracotomy and total knee arthroplasty: a retrospective multicenter study in Japan (Japanese Study Group of Subacute Postoperative Pain).

We performed a multicenter observational study to assess the prevalence and risk factors of persistent pain after lung cancer surgery and total knee arthroplasty (TKA) in the Japanese population. After receiving Ethics Committee approval, a retrospective chart review was performed for patients who underwent surgery at seven university hospitals in Japan in 2013. A total of 511 patients who underwent lung cancer surgery and 298 patients who underwent TKA were included. The prevalence of chronic postsurgical pain (CPSP) at 3 and 6months was 18 and 12% after lung surgery and 49 and 33% after TKA, respectively. The prevalence of analgesic use at 3 and 6months was 16 and 9% after lung surgery and 34 and 22% after TKA, respectively. In both groups, preoperative analgesic use was associated with CPSP. Anesthetic methods or techniques during both types of surgery did not significantly affect the prevalence of CPSP. This is the first study in which the prevalence of CPSP after lung surgery and TKA in Japanese population was extensively evaluated in a multicenter trial. Further prospective studies are needed to confirm the prevalence of CPSP in the Japanese population and to identify risk factors and prevention methods.

Duration of Analgesic Use and Risk of Hearing Loss in Women.

Aspirin, nonsteroidal antiinflammatory drugs (NSAID), and acetaminophen are commonly used. Frequent use of analgesics has been associated with a higher risk of hearing loss. However, the association between duration of analgesic use and the risk of hearing loss is unclear. We investigated the relationship between duration of analgesic use and self-reported hearing loss among 55,850 women in the Nurses' Health Study. Cox proportional hazards regression was used to adjust for potential confounders. During 873,376 person-years of follow-up (1990-2012), longer durations of NSAID use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk =1.10, 95% confidence interval: 1.06, 1.15; P for trend<0.001) and acetaminophen use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk =1.09, 95% confidence interval: 1.04, 1.14; P for trend<0.001) were associated with higher risks of hearing loss. Duration of aspirin use was not associated with hearing loss (for >6 years of use compared with <1 year, multivariable-adjusted relative risk =1.01, 95% confidence interval: 0.97, 1.05; P for trend =0.35). In this cohort of women, longer durations of NSAID and acetaminophen use were associated with slightly higher risks of hearing loss, but duration of aspirin use was not. Considering the high prevalence of analgesic use, this may be an important modifiable contributor to hearing loss.

Differences in analgesic use in community-dwelling persons with and without Alzheimer's disease.

There are conflicting findings about analgesic use among persons with cognitive impairment compared to cognitively intact older persons. The objective of our study was to investigate the prevalence of analgesic use in community-dwelling persons with and without Alzheimer's disease (AD), within six months after AD diagnosis and to find out factors associated with the use of analgesics and specific analgesic groups. We utilized data from register based MEDALZ (Medication use and Alzheimer's disease) cohort consisting of all community-dwelling persons diagnosed with AD during 2005-2011 in Finland and their matched comparison persons without AD. Altogether, 67,215 persons with AD and one comparison person for each case were included. Drug use data were collected from the Prescription Register and comorbidities from Special Reimbursement and Hospital Discharge Registers. Statistically significant (p<0.001) yet mostly small differences were found for analgesics use: analgesics were used by 34.9% and 33.5% of persons with and without AD, respectively. Paracetamol was the most frequently used analgesic both among persons with (25.0%) and without AD (19.1%). Persons with AD used less frequently NSAIDs (Nonsteroidal Anti-inflammatory Drugs) (13.2% vs. 17.3%) and mild opioids (5.0% vs. 7.1%), while the use of strong opioids was more common in comparison to persons without AD (1.3% vs. 1.1%, respectively). Analgesic users were more likely women, aged ≥80years, had asthma/COPD, cardiovascular disease, diabetes, cancer, hip fracture, osteoporosis, rheumatoid arthritis, and lower socioeconomic position. Further studies are needed to evaluate the adequateness of pain relief in older persons with and without AD. Persons with Alzheimer's disease (AD) used more frequently paracetamol and less frequently NSAIDs and mild opioids. A decreasing trend of NSAID use was observed among persons with AD during the study period.

Analgesic use and pain in residents with and without dementia in aged care facilities: A cross-sectional study

To investigate analgesic use and pain in people with and without dementia in Australian residential aged are facilities. A cross-sectional study of 383 residents of six residential aged are facilities was conducted. Nurses assessed self-reported and clinician-observed pain. Analgesic use data were extracted from medication charts. Logistic regression was used to investigate factors associated with analgesic use. Analgesics were administered to 291 (76.0%) residents in the previous 24 hours. The prevalence of analgesic use was similar among residents with and without dementia (79.3% vs 73.4%, P = 0.20). Residents with dementia had a higher prevalence of self-reported pain than those without dementia but similar prevalence of clinician-observed pain. In residents with dementia, high care residence and dementia severity were associated with analgesic use. The prevalence of analgesic use was similar among residents with and without dementia. Both self-reported and clinician-observed measures are needed in regular pain assessments.

Management of headache and associated factors among undergraduate medicine and health science students of University of Gondar, North West Ethiopia.

BackgroundThe headache disorders, namely, migraine and tension type headache and the associated analgesic consumption is badly underestimated and thus makes a major current public health problem. The objective of this study was to determine the prevalence of migraine and tension type headaches and the associated management options used among undergraduate students of College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.MethodInstitution based cross sectional study was conducted among 720 students in May, 2014. Pretested and structured self-administered questionnaires were used as data collecting tool followed by short interview to diagnose the type of headache based on the International Headache Society diagnostic criteria. SPSS version 20 was also used to analyse the data descriptively as well as inferentially using logistic regression models to investigate factors associated with presence of headache and analgesic use.ResultThe prevalence of lifetime headache and headache in the last 12 months was 81.11 and 67.22 %, respectively. Migraine and tension type headache were having 94 (13.06 %) and 481 (66.81 %) prevalence, respectively. Prevalence of life time headache was significant among females, students with family history of headache and lack of adequate vacation time. Similarly, lifetime prevalence of analgesic use for headache was 72.45 % and it had statistical association with sex, age, type of headache, lack of adequate vacation time and family history of headache. Majority of the students, migraineurs (54.65 %) and the tension type headache sufferers (66.17 %) commonly used paracetamol.ConclusionHigh prevalence without adequate medical care seeking behaviour and the associated significant analgesic consumption necessitate the designing of all rounded strategies to improve the quality of life of individuals with such neurologic disorders.

Prevalence of Analgesic Use and Pain in People with and without Dementia or Cognitive Impairment in Aged Care Facilities: A Systematic Review and Meta-Analysis

Pain is a frequent cause of discomfort and distress in residents in residential aged care facilities (RACFs). Despite the benefits of adequate pain management, there is inconsistency in the literature regarding analgesic use and pain in residents with dementia. The aim of this systematic review was to determine the prevalence of analgesic drug use among residents with and without dementia or cognitive impairment in RACFs. A systematic search of MEDLINE and EMBASE (inception to January 2014) was conducted using Medical Subject Headings and Emtree terms, respectively. Studies were included if they reported prevalence of analgesic use for residents both with and without dementia within the same study. Data extraction and quality assessment was performed independently by two investigators. Data on the prevalence of analgesic use, pain and painful conditions were extracted. Meta-analyses were performed using random effect models. The 7 included studies were of high quality (≥ 5 out of 7 on the adapted Newcastle-Ottawa Scale). Analgesic use in residents with and without dementia or cognitive impairment ranged from 20.2% to 61.2% and 38.8% to 79.6%, respectively. Paracetamol was the most prevalent analgesic in people with and without dementia. Residents with dementia or cognitive impairment had a significantly lower prevalence of analgesic use (odds ratio [OR] 0.576, 95% confidence interval [CI] = 0.406-0.816) and of self-reported and clinician-observed pain (OR 0.355, 95% CI = 0.278-0.454) than residents without cognitive impairment, despite a comparable prevalence of painful conditions. These findings may indicate under-reporting and under-detection of pain in persons with dementia, and subsequent suboptimal treatment.

Analgesic use before and after oral anticoagulant initiation--a population-based study in Finland.

Due to potential drug-drug interactions and subsequent bleeding risk, analgesic use should be reviewed when an oral anticoagulant is initiated. The aim of this study was to compare use of non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics before and after oral anticoagulant initiation. All individuals who initiated warfarin, dabigatran, or rivaroxaban between January 2012 and September 2013 were identified from the Finnish Prescription Register. Prevalence of analgesic use during 3 months after oral anticoagulant initiation was compared to analgesic use during 4 months before initiation. Analgesics included were NSAIDs, paracetamol, paracetamol in doses ≥ 2 g/day, tramadol, and other opioids. Conditional logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). In total, 54,025 initiated warfarin, 16,894 rivaroxaban, and 1569 dabigatran. The odds of NSAID use decreased among warfarin initiators (odds ratio (OR) 0.10; 95% confidence interval (CI) 0.09-0.10); 2.6% used NSAID after initiation. In contrast, the odds of NSAID use increased among rivaroxaban (OR 3.56; 95% CI 3.37-3.75) and dabigatran initiators (OR 1.44; 95% CI 1.16-1.78). The proportions using NSAIDs after the initiation were 69 and 32%, respectively. However, NSAID use decreased among dabigatran initiators with confirmed atrial fibrillation (OR 0.46; 95% CI 0.23-0.92) and among rivaroxaban initiators with a daily dose of ≥ 15 mg (OR 0.28; 95% CI 0.19-0.40). The use of NSAIDs decreases extensively among warfarin initiators which is encouraging. However, the use of NSAIDs increases among rivaroxaban and dabigatran initiators. This is a concern as the bleeding risk may increase due to potential pharmacodynamic interactions.

Potential underuse of analgesics for recognized pain in nursing home residents with dementia: A cross-sectional study

The expression of pain is altered in people with dementia (PWD), increasing the risk of undertreatment in that population. The objective of this study was to determine whether dementia and the absence of pain assessment in the patients’ medical chart reduced the probability of analgesic use in a large sample of nursing home (NH) residents. This is a cross-sectional study using data from 6275 residents (mean age 86±8.2years; 73.7% women) from 175 NHs located in France. Information on residents’ health status (including dementia and pain assessment) and NHs’ structure and organisation were recorded by the NH staff. The NH staff sent to the research team drug prescriptions participants were taking. They were screened for the use of analgesics (dependent variable) and other medications potentially used for pain management. The prevalence of analgesic use was 46.8% (42.3% for PWD and 52% for people with no dementia). A binary logistic regression showed that PWD (odds ratio 0.75; 95% confidence interval 0.66–0.85) and those who had no pain assessment records (odds ratio 0.64; 95% confidence interval 0.53–0.79) had significant lower probabilities of taking analgesics; these results were independent of pain complaints. Results remained fairly unchanged after performing several sensitivity analyses. Our results suggest that improvements are needed in pain management in NHs, particularly for PWD. Implementing systematic evaluations of pain in NHs’ routine would contribute to a better management of pain, which can lead to important benefits for residents.

Analgesic Use and Frailty among Community-Dwelling Older People

Frail older people have a decreased ability to respond to stressors and may therefore be more susceptible to adverse events related to inadequately treated pain. Conversely, aging- and frailty-related changes in pharmacokinetics and pharmacodynamics may predispose frail older people to adverse events of analgesics. The aim of this study was to explore whether analgesic use is associated with frailty status and whether there are differences in the types of analgesics used between frailty groups among community-dwelling older people. The study population consisted of 605 community-dwelling people aged >75 years. Demographic, diagnostic and drug use data were collected during standardized nurse interviews. Participants were classified as frail, pre-frail or robust using the Cardiovascular Health Study frailty criteria (weight loss, weakness, exhaustion, slowness and low physical activity). Overall, 11.4 % (n = 69) of the study participants were frail and 49.4 % (n = 299) were pre-frail. The prevalence of prescription and non-prescription analgesic use was higher among frail (68.1 %) than among pre-frail (54.5 %) and robust (40.5 %) older people (p < 0.001). In multivariate analyses, frailty was positively associated with analgesic use (odds ratio 2.96; 95 % CI 1.38-6.36). However, frail analgesic users (46.7 %) were more likely to want their physicians to pay greater attention to pain management than robust (23.2 %) analgesic users. The most prevalent analgesic was acetaminophen (paracetamol) among frail (78.7 %) and pre-frail (63.2 %), and NSAIDs among robust (60.4 %) analgesic users. Frail (60.3 %) and pre-frail (58.1 %) participants were more likely to report musculoskeletal pain than robust (44.7 %) participants. Of robust, pre-frail and frail older people 33.0 %, 23.1 % and 4.9 % (respectively) did not use any analgesics to treat their pain. Frailty was associated with a higher prevalence of analgesic use. As frail older people may be more susceptible to adverse events, careful selection of analgesics is warranted. Clinicians should pay more attention to pain management to ensure adequate pain relief.

Analgesic use in a national community sample of German children and adolescents

Previous studies suggest that pain management by analgesic medications may be low among children. This study aims to investigate analgesic use and its correlates among children in Germany. Analgesic use during a 1-week period was investigated in a community sample of 14,836 children and adolescents aged between 3 and 17 years in Germany. SPSS complex sample method was used to estimate the prevalence and associated factors of analgesic use among the general child population and among those children with pain in the same child population. The prevalence of analgesic use was 8.9% among the general child population and 17.5% among children with pain that occurred at least once a week. Paracetamol (acetaminophen), aspirin and ibuprofen were the most frequently used paediatric analgesics, accounting for two-thirds of all analgesics. The vast majority of painkillers were self-medicated (67%, bought over the counter or obtained from other sources), used for a short term within 1 week (92%) and taken for the treatment of pain (85%). Use of analgesics was closely associated with girls, older age groups, children with a poor overall health status and children with recurrent pain, irrespective of family immigrant background and socioeconomic status. Analgesic use appears to be low among children in Germany, reflecting largely the fact that pain perceived among children under ambulant care may be mild to moderate and does not need analgesic medications. As the majority of paediatric analgesics were self-medicated, use of analgesics still should be closely monitored particularly among specific subpopulations such as adolescents to avoid potential abuse.

Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study

Background: Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics. Objectives: The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged ≥75 years, and to investigate factors associated with daily and as-needed analgesic use. Methods: A random sample of people aged ≥75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good). Results: Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of ≥1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95°% CI, 1.17–2.71]), living alone (OR, 1.46 [95°% CI, 1.02–2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22–3.84]), and use of ≥10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26–3.87]). Among users of ≥1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03–6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04–0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics. Conclusions: Analgesics were used by ~50% of community-dwelling people aged ≥75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of ≥10 nonanalgesic drugs.

Use of analgesics in adults with pain complaints: prevalence and associated factors, Turkey

OBJECTIVE: Use of analgesics has been increasingly recognized as a major public health issue with important consequences in Turkey. The objective of the study was to determine the prevalence and patterns of analgesics usage and associated factors in adults with pain complaints. METHODS: A cross-sectional study was conducted in 15 cities selected from five demographic regions in Turkey. The study sample population comprised 1.909 adults 18-65 age groups suffering from pain. The sampling method was multi-step stratified weighted quota-adjusted sampling. Data were collected by face-to-face interviews using a semi-structured survey questionnaire consisting of 28 questions. Odds ratios were produced by logistic regression analyses. RESULTS: The prevalence of analgesic use was 73.1%, and it was higher in females (75.7%; p&lt;0.05), in subjects 45-54 years (81.4%; p&lt;0.05), in subjects in rural areas (74.6%; p&lt;0.05), in subjects in northern region (84.3%; p&lt;0.05), in illiterate subjects (79.1%; p&gt;0.05), and in subjects of lower socioeconomic status (74.1%; p&gt;0.05). One in ten of the participants used non-prescription analgesics. Non-prescription analgesics were more prevalent among the 55-65 age groups (18.1%; p&lt;0.05), among female (11.6%; p&gt;0.05), among the urban population (10.7%; p&gt;0.05), and in subjects of lower middle socioeconomic status (13.2%; p&lt;0.05). Logistic regression showed statistically significant ORs only for age groups, duration of education, socioeconomic status, and demographic regions (p&lt;0.05). CONCLUSIONS: The results showed that the prevalence of analgesic use and prescription analgesic use is high in Turkey, and their use is related to sociodemographic characteristics.

A comparison of three questionnaire-based measures of analgesic use over 11 years in adult males: A retrospective analysis of data from a prospective, population-based cohort study

Background: Few data are available on whether 3 commonly used, yet slightly different, questionnaire-based measures assessing the use of analgesics provide congruent and comparable results. Objective: The objective of this study was to compare 3 different measures of analgesic use in 1 study population over an 11-year period. Methods: Data for this study were gathered from a prospective, population-based cohort study in which 3 different measures were applied simultaneously for measuring use of analgesics at baseline, 4 years, and 11 years. The first measure was “weekly analgesic use in general,” the second measure “analgesic use for pain symptoms within the past week,” and the third measure “giving the name of any analgesic used within the past week.” The subjects were Finnish men who completed 11 years of follow-up in the Kuopio Ischemic Heart Disease Risk Factor (KIHD) Study, conducted at the Research Institute of Public Health, University of Kuopio, Kuopio, Finland. Agreement between the 3 different measures was determined by Kappa statistics. Results: A total of 829 men completed 11 years of follow-up (mean [SD] age, 51.4 [6.7] years at baseline; 62.4 [6.5] at study end). At baseline, the prevalence of weekly analgesic use varied from 12.3% to 17.4% and at 11 years from 16.5% to 25.9%, depending on which measure was being used. The third measure yielded the highest prevalence at all 3 points of time and the lowest was obtained using the first measure. The Kappa agreement between the 3 measures at the 3 time points varied from moderate (0.37) to good (0.71). Conclusions: The results of this study suggest that the measure being used influences the obtained prevalence of analgesic use. All 3 measures tested consistently throughout the course of the study. The best results, with regard to determining prevalence, were obtained by asking the respondents to name the medicines they had been using during the previous week.