Undertreatment Of Pain Research Articles

Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS)

BackgroundSeveral pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff. ObjectivesTo develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population. DesignInstrument development and psychometric analysis. MethodsPain assessments (n=180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1min before the procedure, during the procedure (lasting from 0.6 to 11.2min, mean 2.6), and 1min after the procedure. In addition, an expert panel (n=5) and nurses (n=26) participated in the validation of the scale. ResultsA pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses’ expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (p<0.001), indicating a good construct validity of the scale. Correlations between the NIAPAS and NIPS (the Neonatal Infant Pain Score) were high (0.751–0.873). The study also demonstrated high coefficients for inter-rater (r=0.991–0.997) and intra-rater reliability (r=0.992–1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the scale was easy to administer and that it helped decision-making in the pain management of infants. ConclusionsThe NIAPAS was shown to be a valid and reliable scale for assessing acute pain in preterm and full-term infants in the NICU. It allows nurses to evaluate infants’ acute pain especially during painful procedures and help to provide pain relief for the infants.

Understanding the pain status of the patient: a survey of pain status and pain treatment in an orthopedic outpatient department

Abstract Background: Pain assessments help clinicians to evaluate their patients’ symptoms. However, patients’ satisfaction with pain management is difficult to interpret and may mislead the clinician into being satisfied with inadequate pain management. Objective: We described and explored patients’ pain status, patients’ satisfaction with their pain management, the impact of pain on sleep habit and routine activities of daily living (ADLs), and the proportion of patients who had undertreatment of pain in the Orthopaedic Outpatient Department, Ramathibodi Hospital. Methods: A prospective, cross-sectional survey study of pain characteristics and pain management of Orthopaedic outpatients aged over 18 years in the Orthopaedics Department, Ramathibodi Hospital using two parts of a verified questionnaire. Results: In all, 863 patients were studied. Numbers of patients with acute or chronic pain were in similar proportions and mainly diagnosed as nociceptive pain (83.7%). Most of them suffered from moderate or severe pain (42.6% vs. 39.1%). Severity of symptoms was correlated with sleep disturbance and disturbance in ADLs. However, no correlation was revealed between satisfaction with pain management and the intensity of pain and there was also no correlation between satisfaction with pain management and sleep disturbance or disturbance in ADLs. Most commonly prescribed medications were nonsteroidal antiinflammatory drugs (NSAIDs) (58.8%). However, 93.4% of returning patients who suffered from severe pain were still treated with nonopioid analgesics. Conclusion: Patients suffered from moderate to severe pain and had disturbances in their sleep habit and ADLs. Most of them were satisfied with previous pain management, which was usually with nonopioid analgesics including NSAIDs and muscle relaxants. This group included some patients who experienced a high intensity of pain. We recommend clinicians pay more attention to the pain intensity of individual patients and justify appropriate medication by using a step-up approach and multimodal analgesics

Antinociceptive effects of imidazoline I2 receptor agonists in the formalin test in rats (658.2)

Pain is a significant global public health problem and currently available analgesics are not adequate to meet the clinical needs, leaving a big population with undertreated pain. The imidazoline I2 receptor is an emerging drug target for analgesics as I2 receptor agonists demonstrate antinociceptive effects in rodent models of acute and chronic pain. However, little is known of the neuroanatomical mechanism mediating I2 receptor agonist‐induced antinociception. This study examined the effects of the selective I2 receptor agonists 2‐BFI, BU224, and CR4056 using the formalin test in rats. 2‐BFI (1‐10 mg/kg, i.p.) and BU224 (1‐10 mg/kg, i.p.) dose‐dependently attenuated the spontaneous flinching behavior observed during 10min (phase 1) and 20‐60min (phase 2) following formalin (2%, 50µl) treatment, while CR4056 (1‐32 mg/kg, i.p.) only decreased phase 2 flinching. Local administration of 2‐BFI (1‐10 mg/kg, s.c.) to the hindpaw of rats had no antinociceptive effects. In contrast, centrally delivered 2‐BFI (10‐100 µg, i.c.v.) dose‐dependently attenuated phase 1 and phase 2 flinching. Together, these data suggest that I2 receptor agonists produce significant antinociception via a central mechanism and further supports that I2 receptors may represent a novel drug target to treat pain. (DA034806)Grant Funding Source: Supported by R01 DA034806/DA/NIDA NIH HHS/United States

(103) The relation of age on the treatment of patients presenting to the emergency department with pain: a comparison of emerging adults and adults

Oligoanalgesia is a significant problem in the Emergency Departments (ED). Previous research has indicated that children and adolescents are more likely to experience under-treatment of pain in the ED due to a variety of factors. It is likely that emerging adults, individuals aged between 18 and 29 years, experience similar age-related disparities. However, there is a paucity of literature examining the experience of emerging adults in context of pain treatment during ED visits. The present study aimed to compare emerging adults presenting to the ED with a primary complaint of pain to adults (patients 30 years and older) in terms of pain variables and treatment.

Opioid formulations with sequestered naltrexone: a perspective review.

In response to good-intentioned efforts to correct the traditional undertreatment of pain, opioid prescribing experienced a dramatic increase over the past decade. But there is now concern that the pendulum has swung too far in the opposite direction, with a rise in morbidity and mortality associated with prescription opioid misuse and abuse. Yet despite potential problems, opioids are a mainstay for the treatment of pain and are an important component of a comprehensive pain management strategy. Therefore, the overall goal of pain management is to decrease pain and to improve patient functioning and quality of life, while monitoring for adverse effects or aberrant behaviors. That is, to balance effective chronic pain management with appropriate use of opioids. Toward this end, several abuse deterrent strategies (formulations) have been, and continue to be, developed. Several major ones are reviewed here. These products should be a first step in trying to address diversion and abuse in a manner that does not discriminate against any particular patient and aligns with universal prescribing precautions. They should also comprise only one aspect of an overall opioid risk management plan.

Tool for Evaluating the Ways Nurses Assess Pain (TENAP): Psychometric Properties Assessment

Elderly people with cognitive impairment are at risk for under-treatment of pain due to their inability to communicate. Poor knowledge and attitudes of nurses toward pain in this population may result in inadequate pain assessment. This study used a descriptive correlational design to develop and validate a tool to assess nurses' knowledge, attitudes, and reported practice of pain assessment in cognitively impaired elderly patients in acute care settings. The Tool for Evaluating the ways Nurses Assess Pain (TENAP) has two sections: (1) nurses' knowledge and attitudes about pain assessment and management and (2) two vignettes to assess reported practice. Content validity was established by an expert panel of three geriatric-trained nurse clinicians, and pilot tested with a convenience sample of 10 nurses. The psychometric properties were tested with a sample of 263 Registered and Enrolled nurses working in medical wards of two public hospitals in Singapore. The final version of TENAP comprised 29 items. Content validity index ranged from 0.84 to 1.00. The scale took 10 to 15 minutes to complete and items were easily understood. Results from the factor analysis suggested that Section A demonstrated one factor (13 items) while Section B had two distinct factors (16 items), one for each vignette, supporting construct validity of the scale. Cronbach's alphas for all factors were acceptable. TENAP was feasible, valid, and reliable for assessing nurses' knowledge, attitudes, and reported practice of pain assessment in cognitively-impaired elderly patients. Further testing of the tool with a larger sample of nurses in other practice contexts is needed.

Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls

BackgroundThe evidence of undertreatment of pain in patients with dementia is inconsistent. This may largely be due to methodological differences and shortcomings of studies. In a large cohort of patients with incident dementia and age- and sex-matched controls we examined (1) how often they receive diagnoses indicating pain, (2) how often they receive analgesics and (3) in which agents and formulations.MethodsUsing health insurance claims data we identified 1,848 patients with a first diagnosis of dementia aged ≥ 65 years and 7,385 age- and sex-matched controls. We analysed differences in diagnoses indicating pain and analgesic drugs prescribed between these two groups within the incidence year. We further fitted logistic regression models and stepwise adjusted for several covariates to study the relation between dementia and analgesics.ResultsOn average, patients were 78.7 years old (48% female). The proportions receiving at least one diagnosis indicating pain were similar between the dementia and control group (74.4% vs. 72.5%; p = 0.11). The proportion who received analgesics was higher in patients with dementia in the crude analysis (47.5% vs. 44.7%; OR: 1.12; 95% CI: 1.01-1.24), but was significantly lower when adjusted for socio-demographic variables, care dependency, comorbidities and diagnoses indicating pain (OR: 0.78; 95% CI: 0.68-0.88). Analgesics in liquid form such as metamizole and tramadol were more often used in dementia.ConclusionsOur findings show a comparable documentation of diagnoses indicating pain in persons with incident dementia compared to those without. However, there still seems to be an undertreatment of pain in patients with dementia. Irrespective of dementia, analgesics seem to be more often prescribed to sicker patients and to control pain in the context of mobility.

An assessment of basic pain knowledge and impact of pain education on Indian Anaesthesiologists - a pre and post questionnaire study.

Background and Aim:Under-treatment of pain is a global phenomenon and the basic knowledge of pain amongst health care providers continues to be deficient. The aim of this study was to determine the basic prevalent knowledge of pain among Indian anaesthesiologists and the impact of a pain educational programme on their existing knowledge.Methods:A nine lectures pain continuing medical education (CME) program was conducted for 114 young anaesthesiologists. All delegates were given 21-item questionnaire in a pre and post-test design. The 69 paired responses were compared for individual questions using McNemar test and the overall improvement in knowledge was analysed using paired t-test.Results:The pre-test score for correct answers was 61.9%. The post-test score was 69.8% and this improvement was found to be statistically significant (P < 0.001). A significant improvement in perception was detected that ‘opioids usage was less likely to cause addiction’ (correct responses increased from 4.2 to 77.4%, P = 0.001).Conclusion:The questionnaire study found that the current basic knowledge about pain amongst young anaesthesiologists is deficient. The physician's major concerns were opioid addiction and respiratory depression with opioid usage. The results of pre and post-test questionnaire survey have shown that pain education can help in improving knowledge of pain management.

Hospitalized children continue to report undertreated and preventable pain.

Published reports of substantial rates of moderate to severe pediatric inpatient pain tend to overlook lower-intensity pain that may be clinically significant. To document the prevalence of clinically significant pain in pediatric inpatients by considering the pain threshold at which each child desires intervention, and to assess sources of pain, pain assessment and intervention, and relationships among demographic and medical variables to reported pain. Inpatients or their parents on four hospital units during four nonconsecutive days were eligible for inclusion. Interviews (76 parents; 31&nbsp;patients) captured experiences of 107 inpatients (three weeks to 18&nbsp;years of age) including current, worst and usual pain, pain treatment thresholds, sources of pain and help received during the previous 24 h. A chart review provided data regarding demographic and medical variables, and pain assessment and management. In total, 94% of patients experienced pain. The prevalence of clinically significant pain was 8% (current), 62% (worst) and 24% (usual). Current and worst pain was primarily procedural, and usual pain was primarily disease related. On average, patients had 4.03 documented pain assessments over 24 h. Caregiver responses (eg, reassurance) and nonpharmacological interventions were frequently reported (>90%) but infrequently documented (<50%); 66% of patients received pharmacological interventions. Younger patients received fewer pain assessments and opioids. Patients with clinically significant usual pain were more likely to have undergone surgery, and receive more pain assessments and interventions. While recent studies suggest reduced pain in pediatric inpatients, the present findings reveal a continued high frequency of undertreated pain. High rates of procedural pain are preventable and should be targeted given the underutilization of pain management strategies.

English

Objective: Undertreated pain around the world includes the acute and chronic pain caused by sickle cell disease (SCD). In collaboration with a Caribbean association that aims to provide assistance to those diagnosed with SCD, we surveyed adults with SCD about pain management and impact of SCD pain. Methods: Participants were recruited from a group of 55 adults with

EPA-0774 – Improving the quality of care through pain assessment and management

Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families. It is of utmost importance to valuation, assessment and pain relief, presenting these as vital elements in contributing to the welfare and quality of life of the individual, and its control a person's right and duty of health professionals. To understand how nurses cope with the pain phenomenon and its evaluation in the context of a continuing care unit. This is a descriptive-exploratory study, with qualitative methodological approach. Data were collected based using semi-structured interviews, participant observation and documentary analysis of nursing records. The study included five nurses from a continuing care unit at the Santa Casa da Misericórdia Hospital, Tábua, Portugal. There were conducted 10 interviews, 25 participant observations and consult of 25 nursing records, over a period of 60 days. The results obtained allow us to know the main problems of the nurse in the identification and characterization of the pain of the user taking into account their individuality, the performance of non-pharmacological and/or pharmacological taking into account the degree of pain and subsequently identified the election by each nurse the information recorded in the register of Nursing. Education about safe pain management will help prevent undertreatment of pain and the resulting harmful effects. Safety includes the use of appropriate tools for assessing pain in cognitively intact adults and cognitively impaired adults. Otherwise pain may be unrecognized or underestimated.

Postoperative Pain Management in Children, Parental English Proficiency, and Access to Interpretation

Patients with limited English proficiency (LEP) are at risk for undertreated pain. The goal of this study was to examine the association between parental language proficiency, interpreted care, and postsurgical pediatric pain management. This was a retrospective matched cohort study among children <18 years of age. Children of LEP and English-proficient (EP) parents were matched according to age group, surgical procedure, and admission date. Mean number of daily pain assessments and mean daily pain scores were compared between language groups. We also compared the association between pain scores and type of medication given (opioid versus nonopioid). Within the LEP group, similar analyses compared pain assessment and treatment of children whose families received ≥ 2 professional interpretations per day versus those who received lower rates of interpretation. A total of 474 children (237 LEP and 237 EP) were included in the study. Children of LEP parents had fewer pain assessments (mean: 7 [95% confidence interval: 2-13] vs 9 [95% confidence interval: 4-15]; P = .012), and higher levels of pain recorded before receiving opioid analgesics, compared with children of EP parents (P = .003). Within the LEP group, children with ≥ 2 interpretations per day had lower pain scores after medication administration (P < .05) and were more likely to receive opioids at pain levels similar to those of EP families. Children of LEP parents received fewer pain assessments and were less likely to receive opioid analgesics for similar levels of pain compared with children of EP parents. More frequent use of professional interpreters when assessing pain may aid in reducing the gap in pain management between LEP and EP pediatric patients.

Pharmacovigilence and the Plight of Chronic Pain Patients: In Pursuit of a Realistic and Responsible Ethic of Care

This paper critiques the increasingly prevalent approach in pain management that urges the universal adoption of medication adherence contracts and random urine drug screening as tools for managing the risk involved in prescribing and consuming opioid analgesics. We assess the use of such “universal precautions” through a two-tiered analysis consisting of dyadic and population-level perspectives, a combination of approaches that has rarely been deployed simultaneously in the bioethics literature on the undertreatment of pain. Specifically, in the first portion of the paper, we criticize the turn to opioid contracts in terms of the physician-patient relationship, and demonstrate that properly understood, applied, and documented, scrupulous adherence to informed consent offers all of the benefits and none of the burdens of opioid contracts. In the second portion, we balance the prior emphasis on the therapeutic dyad by leveraging techniques drawn primarily from population-level bioethics. We focus on disease stigma, explain why it is a pressing ethical issue on both descriptive and normative grounds, and show how the use of opioid contracts as part of a universal precautions approach is much more likely to intensify than to ameliorate stigma, contrary to the claims of its proponents.

Under-detection of pain in elderly nursing home residents with moderate to severe dementia

Background/PurposeElderly patients who are cognitively impaired tend to have a decreased ability to communicate and report pain, which results in the under-detection and under-treatment of pain. This study aimed to describe the prevalence of pain in elderly patients with moderate to severe dementia who were residing in nursing homes and to determine the factors associated with pain. MethodsElderly patients older than 60 years of age with Mini-mental State Examination (MMSE) scores of <20 who were resident in three selected nursing homes were recruited. Demographic data and comorbidity were recorded. Information about treatment with analgesic drugs, physical restraints, the presence of depression, and behavioral disturbances was collected from medical records and from health care workers. Pain was assessed using the Chinese version of the Pain Assessment in Advanced Dementia Scale (PAINAD-C). ResultsA total of 309 residents with a mean ± SD age of 85 ± 7.5 years and a mean ± SD MMSE score of 9.6 ± 6.3 were included in the study. A total of 61.5% (190) of patients experienced pain as defined by a PAINAD-C score of ≥2. Only 30.7% (95) of patients were treated with analgesic drugs. Univariate analysis showed that a lower MMSE score, male sex, poor mobility level, treatment with psychotropic drugs, use of physical restraints, presence of physical aggression, and being uncommunicative were associated with pain. The major factors associated with pain were the use of physical restraints [odds ratio (OR) 3.1], the presence of physical aggression (OR 2.55), male sex (OR 2), and poor MMSE score (OR 0.94). ConclusionPain is highly prevalent among nursing home residents with moderate to severe dementia and is associated with the use of restraints. However, only half of the patients in this study were treated with analgesic drugs. An improvement in the caregivers' knowledge of pain assessment together with the provision of adequate treatment for pain is necessary in the care of these groups of patients with dementia.

Undertreatment of pain in the prehospital setting

The aim of this study was to evaluate pain treatment with morphine administered by emergency medical service personnel (EMSP) to patients with chest pain and patients with pain in extremities because of trauma. This is a retrospective chart review of 2021 patients with chest pain and 887 patients with trauma. Pain was assessed using a 0-10 Numerical Rating Scale, and measured at the beginning and at the end of the ambulance care period. Trauma patients experienced more pain both at the start and at the end of the treatment than patients with chest pain [median 8 (interquartile ranges (IQR 6-9)) vs. 6 (IQR 4-7) and 4 (IQR 2-6) vs. 2 (IQR 0-4), P<0.001], but were treated with similar doses as in patients with chest pain [median 7.5 (IQR 5-10) and 5 (IQR 2.5-7.5), P=0.09]. Inadequate analgesia was frequently observed for both patient groups. The protocol was not fully utilized, suggesting that education in pharmacology and follow-up of the EMSP is required.

Management of chronic pain with chronic opioid therapy in patients with substance use disorders

Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.

“Nonmedical” prescription opioid use in North America: a call for priority action

Nearly four years after the United States Congress heralded a “decade of pain control and research”, chronic pain remains a mounting public health concern worldwide. The escalating prevalence of chronic pain in recent years has been paralleled by a rise in prescription opioid availability, misuse, and associated human and social costs. However, national monitoring surveys in the U.S. and Canada currently fail to differentiate between prescription opioid misuse for the purposes of euphoria versus pain or withdrawal management. Furthermore, there is a lack of evidence-based guidelines for pain management among high-risk individuals, and a glaring lack of education for practitioners in the areas of pain and addiction medicine. Herein we propose multiple avenues for intervention and research in order to mitigate the individual, social and structural problems related to undertreated pain and prescription opioid misuse.

Is Fever Treated More Promptly Than Pain in the Pediatric Emergency Department?

BackgroundFever can be treated with a higher priority than pain in the pediatric emergency department (ED) population. ObjectiveThe primary objective was to assess whether patients with a fever are treated with acetaminophen or ibuprofen more promptly than they are treated for pain. MethodsA retrospective descriptive study was performed on all patients between the ages of 3 and 19 years who received acetaminophen or ibuprofen in the pediatric ED from February 1, 2010 to January 31, 2011. The time interval from arrival to treatment with acetaminophen or ibuprofen was compared for those patients with a fever (≥100.4°F) and those without a fever and had reported pain. Other measurable points (time of vital signs, bed assignment, and medication order) on the medical record were compared to further describe any differences. ResultsPediatric patients with fever (n = 1097) received ibuprofen or acetaminophen a median of 54.0 min (interquartile range [IQR], 35.4−89.3 min) after arrival. The corresponding median time for afebrile patients (n = 1861) that received the same medications was 83.2 min (IQR, 52.7−136.1). The difference between medians was 24.6 min (95% confidence interval 21.3−27.9 min). ConclusionsFever is treated more promptly than pain in the pediatric ED. This difference is associated with prevailing and largely unfounded concerns about fever and the undertreatment of pain (oligoanalgesia).

Upscheduling of Hydrocodone: Convenience and Access vs Patient Safety Measures

The Controlled Substance Act of 1970 designates drugs into one of five schedules, based upon medicinal value, harmfulness, and potential for abuse and addiction [1]. Schedule I drugs are those considered to have a high potential for abuse with no medicinal value, Schedule II drugs have a high potential for abuse with medicinal value, Schedule III designates drugs that have a lower potential for abuse than Schedule I and II drugs, Schedule IV drugs have a low potential for abuse, and Schedule V drugs are thought to have an abuse potential even lower than those designated as Schedule IV. A controversial decision by the US Food and Drug Administration (FDA) in 1971 permitted hydrocodone to have a split Schedule, with pure hydrocodone designated as a Schedule II drug and hydrocodone combined with acetaminophen designated as Schedule III [2]. However, at present, hydrocodone is not sold commercially in the United States in its pure form, but rather always in combination with another medication. In January of 2013, an FDA advisory committee determined that hydrocodone required tighter regulation owing to its high abuse potential. Accordingly the recommendation was to upschedule hydrocodone combination products from Schedule III to Schedule II. Currently, the FDA is deciding whether it will enact the advisory committee’s recommendation. The issue, the committee recommendation, and the history of FDAs stance have generated significant controvery. In this month’s Ethics Forum, Dr. Andrew Kolodny, the President of Physicians for Responsible Opioid Prescribing (PROP) elucidates the position that the upscheduling of hydrocodone is an imperative based upon its potential for abuse and lethality. The opposing viewpoint is presented by Dr. Anna Lee and Dr. Jeffrey Gudin, a nationally renowned pain management specialist; both physicians are concerned with the potential negative consequences associated with reclassification; namely, the undertreatment of pain.

Under treatment of pain: a prescription for opioid misuse among the elderly?

To examine the demographic, physical, and mental health characteristics; current drug use patterns; motivations for use; and diversion sources among elderly prescription opioid misusers. Mixed methods design. Research field offices, or senior or community center offices in South Florida. Individuals aged 60 and over reporting past 90-day prescription medication misuse; only prescription opioid misusers (N = 88) were included in the final analysis. The Global Appraisal of Individual Needs was the main survey instrument. A subsample of elderly reporting substantial prescription drug misuse were chosen for the in-depth interview (N = 30). The mean age was 63.3. Fifty percent reported ever being admitted to a drug treatment program; several endorsed recent illicit drug use: powder cocaine and/or crack (35.2%), marijuana (30.7%), heroin (14.8%). The majority reported past year severe physical pain and discomfort (86.4%), and misuse of their primary opioid for pain (80.7%); over half (52.3%) obtained their primary opioid from their regular doctor. Qualitative data highlight the misuse of prescription opioids due to untreated or undertreated pain. Participants with primary opioid misuse for pain had over 12 times higher odds of obtaining the medication from their regular doctor (odds ratio [OR] = 12.22, P = 0.002) and had lower odds of using a dealer (OR = 0.20, P = 0.005). Findings suggest that this group of elderly participants often misuse their own prescriptions for pain management. This study highlights the need to educate prescribing professionals on appropriate pain management for older adults while still being sensitive to issues of substance abuse and dependence.