Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-27T18:47:07.183Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project

Published online by Cambridge University Press:  24 July 2013

Jordan F. Karp ,
Ching-Wen Lee ,
Jonathan McGovern ,
Gary Stoehr ,
Chung-Chou H. Chang  and
Mary Ganguli
Jordan F. Karp*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Ching-Wen Lee
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Jonathan McGovern
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Gary Stoehr
Affiliation:
School of Pharmacy, D’Youville College, Buffalo, NY, USA
Chung-Chou H. Chang
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Mary Ganguli
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
*
Correspondence should be addressed to: Jordan F. Karp, MD, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA. Phone: +1-412-246-6048; Fax: +1-412-246-6030. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002.

Methods:

Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use.

Results:

The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance.

Conclusions:

These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management.

Keywords

agingepidemiologymedical comorbiditypainruralsleep
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 11 , November 2013 , pp. 1801 - 1810
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

AGS Panel on Chronic Pain in Older Persons (2002). The management of chronic pain in older persons. Journal of the American Geriatrics Society, 50, S205–S224.Google Scholar
American Society of Health-System Pharmacists (1987). AHFS Drug Information 1987. Bethesda, MD: American Society of Health-System Pharmacists.Google Scholar
Bergmann, B. M., Landis, C. A., Zenko, C. E. and Rechtschaffen, A. (1993). Sleep deprivation in the rat: XVII. Effect of aspirin on elevated body temperature. Sleep, 16, 221–225.CrossRefGoogle ScholarPubMed
Brennan, M. J. and Lieberman, J. A., 3rd (2009). Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes. Current Medical Research and Opinion, 25, 1045–1055.CrossRefGoogle ScholarPubMed
Brennan, P. L., Schutte, K. K. and Moos, R. H. (2005). Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers.[see comment]. Addiction, 100, 777–786.CrossRefGoogle ScholarPubMed
Campbell, C. I.et al. (2010). Age and gender trends in long-term opioid analgesic use for noncancer pain. American Journal of Public Health, 100, 2541–2547.CrossRefGoogle ScholarPubMed
Cicero, T. J., Surratt, H., Inciardi, J. A. and Munoz, A. (2007). Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiology and Drug Safety, 16, 827–840.CrossRefGoogle Scholar
Fetveit, A. (2009). Late-life insomnia: a review. Geriatrics and Gerontology International, 9, 220–234.CrossRefGoogle ScholarPubMed
Fick, D. M.et al. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of Internal Medicine, 163, 2716–2724.CrossRefGoogle ScholarPubMed
Fishbain, D. A., Cole, B., Lewis, J. E. and Gao, J. (2009). What is the evidence for chronic pain being etiologically associated with the DSM-IV category of sleep disorder due to a general medical condition? A structured evidence-based review. Pain Medicine, 11, 158–179.CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S. and McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Ganguli, M., Dodge, H. H., Chen, P., Belle, S. and DeKosky, S. T. (2000). Ten-year incidence of dementia in a rural elderly US community population: the MoVIES Project. Neurology, 54, 1109–1116.CrossRefGoogle Scholar
Ganguli, M., Dodge, H. H. and Mulsant, B. H. (2002). Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression. Archives of General Psychiatry, 59, 1046–1052.CrossRefGoogle Scholar
Ganguli, M., Gilby, J., Seaberg, E. and Belle, S. (1995). Depressive symptoms and associated factors in a rural elderly population: the MoVIES Project. American Journal of Geriatric Psychiatry, 3, 1440160.CrossRefGoogle Scholar
Hanlon, J. T., Fillenbaum, G. G., Studenski, S. A., Ziqubu-Page, T. and Wall, W. E. Jr. (1996). Factors associated with suboptimal analgesic use in community-dwelling elderly. Annals of Pharmacotherapy, 30, 739–744.CrossRefGoogle ScholarPubMed
Heller, H. C., Edgar, D. M., Grahn, D. A. and Glotzbach, S. F. (2011). Sleep, thermoregulation, and circadian rhythms. Comprehensive Physiology, (Suppl. 14), 1361–1374.Google Scholar
Horne, J. A. (1989). Aspirin and nonfebrile waking oral temperature in healthy men and women: links with SWS changes? Sleep, 12, 516–521.CrossRefGoogle ScholarPubMed
Jones, B., Nagin, D. and Roeder, K. (2001). A SAS procedure based on mixture models for estimating developmental trajectories. Sociological Research and Methods, 29, 374–393.CrossRefGoogle Scholar
Kamal-Bahl, S. J., Doshi, J. A., Stuart, B. C. and Briesacher, B. A. (2003). Propoxyphene use by community-dwelling and institutionalized elderly medicare beneficiaries. Journal of the American Geriatrics Society, 51, 1099–1104.CrossRefGoogle ScholarPubMed
Karp, J. and Reynolds, C. (2009). Depression, pain, and aging. Focus, 7, 17–27.CrossRefGoogle Scholar
Lamberg, L. (1999). Chronic pain linked with poor sleep; exploration of causes and treatment. JAMA, 281, 691–692.CrossRefGoogle ScholarPubMed
Lassila, H. C.et al. (1996). Use of prescription medications in an elderly rural population: the MoVIES Project. Annals of Pharmacotherapy, 30, 589–595.CrossRefGoogle Scholar
Lin, E. H.et al. (2003). Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA, 290, 2428–2429.CrossRefGoogle ScholarPubMed
Lustberg, L. and Reynolds, C. (2000). Depression and insomnia: questions of cause and effect. Sleep Medicine Reviews, 4, 253–262.CrossRefGoogle ScholarPubMed
Lydic, R. and Baghdoyan, H. (2007). Neurochemical mechanisms mediating opioid-induced REM sleep disruption. In Lavigne, G., Sessle, B., Choiniere, M. and Soja, P. (eds.), Sleep and Pain (pp. 99–122). Seattle, WA: IASP Press.Google Scholar
Mantyselka, P. T., Turunen, J. H., Ahonen, R. S. and Kumpusalo, E. A. (2003). Chronic pain and poor self-rated health. JAMA, 290, 2435–2442.CrossRefGoogle ScholarPubMed
Murray, M. D.et al. (1995). Acute and chronic effects of nonsteroidal anti inflammatory drugs on glomerular filtration rate in elderly patients. American Journal of the Medical Sciences, 310, 188–197.CrossRefGoogle ScholarPubMed
Page, J. and Henry, D. (2000). Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an underrecognized public health problem. Archives of Internal Medicine, 160, 777–784.CrossRefGoogle ScholarPubMed
Parsells Kelly, J.et al. (2008). Prevalence and characteristics of opioid use in the US adult population. Pain, 138, 507–513.CrossRefGoogle Scholar
Paturi, A. K., Surani, S. and Ramar, K. (2011). Sleep among opioid users. Postgraduate Medicine, 123, 80–87.CrossRefGoogle ScholarPubMed
Rios, R. and Zautra, A. J. (2011). Socioeconomic disparities in pain: the role of economic hardship and daily financial worry. Health Psychology, 30, 58–66.CrossRefGoogle ScholarPubMed
Smith, M. T.et al. (2009). Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep, 32, 779–790.CrossRefGoogle ScholarPubMed
Solomon, D. H.et al. (2010). The comparative safety of opioids for nonmalignant pain in older adults. Archives of Internal Medicine, 170, 1979–1986.CrossRefGoogle ScholarPubMed
Urwin, M.et al. (1998). Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Annals of the Rheumatic Diseases, 57, 649–655.CrossRefGoogle ScholarPubMed