Opioids and Adjuvants for Pain in Nursing Home Residents with Cancer

阿片类药物和佐剂用于治疗癌症疗养院居民的疼痛

• 批准号: 8953021
• 负责人: Kate L Lapane
• 金额: $ 21.86万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8953021
• 关键词: Absence of pain sensation; Adjuvant; Adjuvant Analgesic; Admission activity; Adverse effects; Adverse event; Age; Agreement; Americas; Analgesics; Anticonvulsants; Antidepressive Agents; Attenuated; Breast; Caring; Certification; Clinical Practice Guideline; Clinical Research; Comorbidity; Constipation; Data; Data Set; Data Sources; Databases; Demographic Aging; Diagnosis; Dose; Drug Kinetics; Effectiveness; Elderly; Elements; Eligibility Determination; Ensure; Ethnic Origin; Evaluation; Fracture; Frail Elderly; Future; Gap Junctions; Gender; Goals; Healthcare; Hemorrhage; Housing; Impaired cognition; Institute of Medicine (U.S.); Intervention; Intervention Studies; Knowledge; Longitudinal Studies; Lung; Malignant Neoplasms; Medicare; Medicare claim; Medicare/Medicaid; Medication Management; Mental Depression; Methods; Morphine; National Cancer Institute; Nursing Homes; Opioid; Outcome; Pain; Pain management; Patient Care; Patients; Pattern; Perception; Pharmacodynamics; Population; Population Characteristics; Prostate; Provider; Race; Randomized; Regimen; Relative (related person); Reporting; Research; Research Design; Risk; Role; Route; Sample Size; Shapes; Sleeplessness; Structural Models; Surveys; System; Time; Update; Vulnerable Populations; Woman; Work; age related; aging population; base; beneficiary; cancer pain; cancer type; chronic pain; crosslink; design; dosage; duloxetine; end of life; experience; falls; gastrointestinal; improved; interest; public health relevance; research study; sound; treatment effect; uptake

 DESCRIPTION (provided by applicant): Nearly 1/3rd of Medicare beneficiaries with cancer will receive care in a nursing home (NH). Our preliminary work revealed that among NH residents with cancer, 28.3% had daily pain with 13.5% experiencing severe pain and 61.3% with moderate pain. Opioid use was common for those with daily pain, despite the potential for significant adverse effects such as insomnia, depression, constipation and cognitive impairment. The extent to which adjuvants to analgesia may be used to improve the level of analgesia and ultimately reduce opioid dosage has not been explored in this vulnerable population. The proposed work uses a contemporaneous dataset to provide longitudinal descriptions of the management of pain in newly admitted NH residents with cancer. We propose merging elements of the following existing databases: the Minimum Data Set (MDS), Medicare eligibility and claims data (Part A, B & D), and the Certification and Survey Provider Enhanced Reporting (CASPER) system. Using state of the art analytic methods such as marginal structural models, the specific aims are to: 1) Describe the pattern of analgesic use in terms of "morphine equivalents", route of administration, and use of adjuvants to analgesia in patients newly admitted to NHs with cancer and to compare the level of daily pain, analgesia use, and adjuvant use as a function of age, gender, race/ethnicity and level of cognitive impairment.; 2) Evaluate the extent to which pharmacologic management of pain including the uptake of adjuvants to analgesia intensifies over time in NH residents with cancer; and 3) Quantify the association between adjuvants to pain medication and reduction of opioid dose and potential adverse effects (e.g. constipation). The National Cancer Institute is interested in pursuing clinical research to evaluate the role of adjuvants to chronic pain management (PA-14-225). The proposed exploratory work is a necessary precursor prior to design of an RO1 for the NH context. No studies have attempted to characterize the longitudinal experience of pain and use of opioids and adjuvants in NH residents with cancer. Evaluation of the changes in pain, pharmacologic pain treatments, use of adjuvants and outcomes in a contemporaneous national dataset of NH residents with cancer will form the basis of a scientifically sound larger randomized controlled experiment of the use of adjuvants in pain management in NH settings.

 描述（由申请人提供）：近 1/3 的癌症医疗保险受益人将在疗养院 (NH) 接受护理。我们的初步研究显示，在新罕布什尔州患有癌症的居民中，28.3% 的人每天都会感到疼痛，其中 13.5% 的人经历重度疼痛，61.3% 的人经历中度疼痛。尽管阿片类药物可能会产生严重的副作用，如失眠、抑郁、便秘和认知障碍，但对于那些每天都会感到疼痛的人来说，阿片类药物的使用很常见。在这一弱势群体中，尚未探索镇痛佐剂在多大程度上可用于提高镇痛水平并最终减少阿片类药物剂量。拟议的工作使用同期数据集来提供对新入院的新罕布什尔州癌症居民的疼痛管理的纵向描述。我们建议合并以下现有数据库的元素：最小数据集 (MDS)、医疗保险资格和索赔数据（A、B 和 D 部分）以及认证和调查提供商增强报告 (CASPER) 系统。使用最先进的分析方法，例如边缘结构模型，具体目标是：1）描述新入院的癌症患者的“吗啡当量”、给药途径和镇痛辅助剂使用方面的镇痛使用模式，并比较每日疼痛水平、镇痛使用和辅助剂使用与年龄、性别、种族/民族和认知障碍水平的关系。 2) 评估患有癌症的 NH 居民随着时间的推移，疼痛的药物治疗（包括镇痛佐剂的吸收）加强的程度； 3) 量化止痛药佐剂与阿片类药物剂量减少和潜在不良反应（例如便秘）之间的关联。美国国家癌症研究所有兴趣开展临床研究，以评估佐剂在慢性疼痛管理中的作用 (PA-14-225)。拟议的探索性工作是为 NH 背景设计 RO1 之前的必要前提。目前还没有研究试图描述新罕布什尔州癌症居民的疼痛纵向经历以及阿片类药物和佐剂的使用情况。对 NH 癌症居民同期全国数据集中的疼痛变化、药物疼痛治疗、佐剂的使用和结果进行评估，将构成在 NH 环境中使用佐剂进行疼痛管理的科学合理的大型随机对照实验的基础。