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
Little is known about the factors associated with pain-related outcomes in older adults.
In this observational study, we sought to identify patient factors associated with
improvements in pain intensity in a national cohort of older veterans with chronic
pain. We included 12,924 veterans receiving treatment from the Veterans Health Administration
with persistently elevated numeric rating scale scores in 2010 who had not been prescribed
opioids in the previous 12 months. We examined: 1) percentage decrease over 12 months
in average pain intensity scores relative to average baseline pain intensity score;
and 2) time to sustained improvement in average pain intensity scores, defined as
a 30% reduction in 3-month scores compared with baseline. Average relative improvement
in pain intensity scores from baseline ranged from 25% to 29%; almost two-thirds met
criteria for sustained improvement during the 12-month follow-up period. In models,
higher baseline pain intensity and older age were associated with greater likelihood
of improvement in pain intensity, whereas Veterans Affairs service-connected disability,
mental health, and certain pain-related diagnoses were associated with lower likelihood
of improvement. Opioid prescription initiation during follow-up was associated with
lower likelihood of sustained improvement. The findings call for further characterization
of heterogeneity in pain outcomes in older adults as well as further analysis of the
relationship between prescription opioids and treatment outcomes.
Perspective
This study identified factors associated with improvements in pain intensity in a
national cohort of older veterans with chronic pain. We found that older veterans
frequently show improvements in pain intensity over time, and that opioid prescriptions,
mental health, and certain pain diagnoses are associated with lower likelihood of
improvement.
Key words
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Article info
Publication history
Published online: April 04, 2016
Accepted:
March 24,
2016
Received in revised form:
March 21,
2016
Received:
December 31,
2015
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.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Pain Society
