Highlights
- •Most older veterans with elevated pain intensity improved over time.
- •Higher baseline scores and age were associated with greater likelihood of improvement.
- •Mental health diagnoses were associated with lower likelihood of improvement.
- •Opioid prescription initiation was associated with lower likelihood of improvement.
- •Further study of heterogeneity in pain outcomes in older adults is needed.
Abstract
Perspective
Key words
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainReferences
American College of Surgeons National Surgical Quality Improvement Program: ACS NSQIP Participant Use Data File. Available at: https://www.facs.org/quality-programs/acs-nsqip/program-specifics/participant-use. Accessed March 16, 2016
- Chronic pain in a geographically defined general population: Studies of differences in age, gender, social class, and pain localization.Clin J Pain. 1993; 9: 174-182
- Opioid-induced hyperalgesia: A qualitative systematic review.Anesthesiology. 2006; 104: 570-587
- Opioid use among low back pain patients in primary care: Is opioid prescription associated with disability at 6-month follow-up?.Pain. 2013; 154: 1038-1044
- The impact of disability compensation on long-term treatment outcomes of patients with sciatica due to a lumbar disc herniation.Spine. 2006; 31: 3061-3069
- Depression and pain comorbidity: A literature review.Arch Intern Med. 2003; 163: 2433-2445
- Influence of age on pain relief from analgesics. A study of postoperative patients.JAMA. 1971; 217: 1835-1841
- Statistics notes: Some examples of regression towards the mean.BMJ. 1994; 309: 780
- Predictors of change in pain and physical functioning among post-menopausal women with recurrent pain conditions in the women’s health initiative observational cohort.J Pain. 2012; 13: 64-72
- Age and gender trends in long-term opioid analgesic use for noncancer pain.Am J Public Health. 2010; 100: 2541-2547
- Will this patient develop persistent disabling low back pain?.JAMA. 2010; 303: 1295-1302
- Chronic pain prevalence and analgesic prescribing in a general medical population.J Pain Symptom Manage. 2002; 23: 131-137
- Rapid improvement in pain management: The Veterans Health Administration and the Institute for Healthcare Improvement Collaborative.Clin J Pain. 2003; 19: 298-305
- The classification of patients with chronic pain: age and sex differences.Pain Res Manag. 2001; 6: 142-151
- Patterns of primary care and mortality among patients with schizophrenia or diabetes: A cluster analysis approach to the retrospective study of healthcare utilization.BMC Health Serv Res. 2009; 9: 127
- Adverse effects of chronic opioid therapy for chronic musculoskeletal pain.Nat Rev Rheumatol. 2010; 6: 191-197
- Survey of pain among veterans in Western New York.Pain Manag Nurs. 2006; 7: 12-22
- VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide.U.S. Department of Veterans Affairs, Washington, DC2013
- Trajectories of symptoms and function in older adults with low back disorders.Spine (Phila Pa 1976). 2015; 40: 1352-1362
- Correlates of prescription opioid initiation and long-term opioid use in Veterans with persistent pain.Clin J Pain. 2013; 29: 102-108
- Short-term variability in outpatient pain intensity scores in a national sample of older veterans with chronic pain.Pain Med. 2015; 16: 855-865
- A partnered approach to opioid management, guideline concordant care and the stepped care model of pain management.J Gen Intern Med. 2014; 29: 870-876
- Long-term trajectories of back pain: Cohort study with 7-year follow-up.BMJ Open. 2013; 3: e003838
- Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations.J Pain. 2008; 9: 105-121
- Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: The TROUP study.Clin J Pain. 2010; 26: 1-8
- Associations between gender, coping patterns and functioning for individuals with chronic pain: a systematic review.Pain Res Manag. 2015; 20: 48-55
- Critical issues on opioids in chronic non-cancer pain: An epidemiological study.Pain. 2006; 125: 172-179
- Agreement between electronic medical record-based and self-administered pain numeric rating scale: Clinical and research implications.Med Care. 2013; 51: 245-250
- Proportional hazards tests and diagnostics based on weighted residuals.Biometrika. 1994; 81: 515-526
- A cross-national study of the course of persistent pain in primary care.Pain. 2001; 92: 195-200
- Systematic reviews of low back pain prognosis had variable methods and results: Guidance for future prognosis reviews.J Clin Epidemiol. 2009; 62: 781-796.e1
- Using multiple daily pain ratings to improve reliability and assay sensitivity: How many is enough?.J Pain. 2014; 15: 1360-1365
- The epidemiology of chronic pain in a general population: Results of a survey in southern Sweden.Scand J Rheumatol. 2010; 39: 421-429
- The measurement of clinical pain intensity: A comparison of six methods.Pain. 1986; 27: 117-126
- The subjective experience of acute pain. An assessment of the utility of 10 indices.Clin J Pain. 1989; 5: 153-159
- Health-related quality of life in patients served by the Department of Veterans Affairs: Results from the Veterans Health Study.Arch Intern Med. 1998; 158: 626-632
- Veterans’ reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system.J Rehabil Res Dev. 2003; 40: 371-379
- Accuracy of the pain numeric rating scale as a screening test in primary care.J Gen Intern Med. 2007; 22: 1453-1458
- How reliable is pain as the fifth vital sign?.J Am Board Fam Med. 2009; 22: 291-298
- Nature and determinants of the course of chronic low back pain over a 12-month period: A cluster analysis.Phys Ther. 2014; 94: 210-221
- Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination. I. Epidemiologic follow-up study.Pain. 1993; 53: 163-168
- Prognostic factors for musculoskeletal pain in primary care: A systematic review.Br J Gen Pract. 2007; 57: 655-661
- Depression and anxiety associated with three pain conditions: Results from a nationally representative sample.Pain. 2004; 111: 77-83
- Association between substance use disorder status and pain-related function following 12 months of treatment in primary care patients with musculoskeletal pain.J Pain. 2011; 12: 352-359
- Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder.Pain. 2011; 152: 488-497
National Center for Veterans Analysis and Statistics: Profile of Veterans: 2009 Data from the American Community Survey. 2011. Available at: http://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2009_FINAL.pdf. Accessed April 28, 2016.
- VHA Pain Outcomes Toolkit.Department of Veterans Affairs, Washington, DC, U.S.2003
- An examination of the relationship between chronic pain and post-traumatic stress disorder.J Rehabil Res Dev. 2003; 40: 397-405
- Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: A systematic review and meta-analysis.J Am Geriatr Soc. 2010; 58: 1353-1369
- Prevalence and impact of pain among older adults in the United States: Findings from the 2011 National Health and Aging Trends Study.Pain. 2013; 154: 2649-2657
- Prescription and non-prescription analgesic use among the US adult population: Results from the third National Health and Nutrition Examination Survey (NHANES III).Pharmacoepidemiol Drug Saf. 2003; 12: 315-326
- Improving the pharmacologic management of pain in older adults: Identifying the research gaps and methods to address them.Pain Med. 2011; 12: 1336-1357
- Age and race effects on pain sensitivity and modulation among middle-aged and older adults.J Pain. 2014; 15: 272-282
- Comorbidity assessments based on patient report: Results from the Veterans Health Study.J Ambul Care Manage. 2004; 27: 281-295
- Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and Medicaid insurance plans: The TROUP Study.Pain. 2010; 150: 332-339
- Modeling Survival Data: Extending the Cox Model.Springer-Verlag, New York2000
- The prevalence of pain and pain interference in a general population of older adults: Cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP).Pain. 2004; 110: 361-368
- Using electronic health records data to identify patients with chronic pain in a primary care setting.J Am Med Inform Assoc. 2013; 20: e275-e280
- Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.Pain. 2003; 106: 337-345
United States Department of Veterans Affairs. National Center for Veterans Analysis and Statistics: Veteran population. Available at: http://www.va.gov/vetdata/Veteran_Population.asp. Accessed March 16, 2016
- Prevalence of chronic benign pain disorder among adults: A review of the literature.Pain. 1998; 77: 231-239
- Trends in abuse and misuse of prescription opioids among older adults.Drug Alcohol Depend. 2015; 149: 117-121
- Factors that predict poor outcomes in patients with traumatic vertebral body fractures.Injury. 2010; 41: 226-230
Article info
Publication history
Footnotes
This material is based upon work supported by the National Institutes of Health, National Institute on Aging, R03-AG042756 (PI: Dobscha) and the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, CIN 13-404 (PI: Dobscha). Dr. Lovejoy received support from Veterans Health Administration Health Services Research and Development project CDA13-268 during preparation of this report.
The authors have no conflicts of interest to declare.