Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study
Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study
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DOI：
10.1007/s40520-016-0700-9
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发表时间：
2017-12-01
影响因子：
4
通讯作者：
Bean, Jonathan F.
中科院分区：
文献类型：
--
作者：
Nawai, Ampicha;Leveille, Suzanne G.;Bean, Jonathan F.
对多种药物和药物副作用的担忧导致老年疼痛治疗不足。MOBILIZE波士顿研究从2005年到2008年招募了765名年龄在70岁以上的老年人，他们居住在波士顿地区。我们研究了599名在基线时报告慢性疼痛的参与者。使用简明疼痛量表（BPI）严重程度子量表测量的疼痛严重程度分为非常轻度（BPI < 2）、轻度（BPI 2-3.99）和中度至重度（BPI 4-10）。在家庭访谈中记录了前2周服用的药物，一半的参与者报告在前2周使用止痛药。中度至重度疼痛的老年人比非常轻度疼痛的老年人更有可能每天使用一种或多种镇痛药物（分别为49%和11%）。最常用的镇痛药是对乙酰氨基酚（28%）。5%的参与者每天使用阿片类镇痛药。校正健康和人口统计学因素后，疼痛严重程度与每日镇痛药使用密切相关（中度-重度疼痛与极轻度疼痛相比，调整OR 7.19，95% CI 4.02-12.9）。近三分之一的中度至重度疼痛的参与者（30%）认为他们需要更强的止痛药，而这组中有16%的人担心他们使用了太多的止痛药。疼痛管理方面存在严重差距，特别是对于患有最严重慢性疼痛的老年人。需要更大的努力来了解老年人有效疼痛管理和自我管理的障碍。
Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults.The MOBILIZE Boston Study included 765 adults aged ae70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI < 2), mild (BPI 2-3.99), and moderate to severe (BPI 4-10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview.Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49 versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR 7.19, 95% CI 4.02-12.9). Nearly one third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication.Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.