Analgesic safety and effectiveness in older veterans with arthritis

描述（由申请人提供）： 背景资料：老年退伍军人是VHA人群中最大的增长群体，疼痛相关疾病是最常见的健康相关疾病。最近的观察性研究提出了关于老年人疼痛治疗的传统镇痛方案的安全性和有效性的问题。特别是，这些研究引起了对阿片类药物与非甾体抗炎药（NSAID）镇痛药在老年人中的安全性的担忧，这些药物通常是给退伍军人开的。最佳老年人疼痛治疗的研究差距仍然存在，需要更多的循证研究才能得出结论性的建议和指南。目的：以下提案的目的是通过评价3种常用镇痛药物类型（阿片类药物、NSAID、昔布类药物）治疗慢性疼痛患者的安全性和有效性，扩展近期研究的局限性。这将与2个并行项目一起完成，以评估诊断为关节炎的老年退伍军人中镇痛剂的使用。第一项是前瞻性队列研究，第二项将使用国家行政数据。具体目标将确定：1。在诊断为关节炎的老年退伍军人中，常用止痛药的长期安全性，2.常用止痛药对诊断为关节炎的老年退伍军人的有效性，3。预测该队列的阳性和阴性镇痛治疗结局的因素。方法：为了实现这些目标，我们将完成两个针对老年（50岁以上）关节炎退伍军人的项目。第一项研究将前瞻性地调查从四个不同的VA中心的初级保健诊所招募的患有关节炎的老年退伍军人， 规定模式多样性。前瞻性数据收集将使我们能够解决回顾性数据使用的局限性。这些包括收集关于当前疼痛水平、非处方镇痛药使用、功能评分（包括认知功能）和健康行为因素（例如，吸烟）。第二项研究使用了美国退伍军人的国家队列，并复制了一项有争议的研究，比较了止痛药在患有骨关节炎的退伍军人队列中的安全性。 使用2010-2014年的退伍军人纵向队列，将使用倾向评分匹配队列和工具变量分析确定NSAID、选择性昔布类和阿片类药物的比较安全性。退伍军人健康管理数据与医疗保险和医疗补助索赔数据相关联，将允许对患者安全结果进行强有力的评估。

DESCRIPTION (provided by applicant): Background: Aging veterans are the largest growing cohort in the VHA population and pain related disorders are the most prevalent of health related conditions. Recent observational studies have raised questions about the safety and effectiveness of conventional analgesic regimens for pain treatment in older adults. In particular, these studies have raised concerns about the safety of opioids versus non-steroidal anti-inflammatory drugs (NSAIDs) of analgesics in older adults, medications commonly prescribed to veterans. Research gaps in optimal older adult pain treatment remain and more evidence-based research is needed before conclusive recommendations and guidelines can be endorsed. Objectives: The objectives of the following proposal are to expand upon the limitations of recent studies by evaluating the safety and effectiveness of 3 commonly used analgesic medications types (opioids, NSAIDs, coxibs) for patients with chronic pain. This will be done with 2 concurrent projects evaluating analgesic use in older veterans diagnosed with arthritis. The first will be a prospective cohort study, the secon will use national administrative data. Specific aims will be to determine: 1. the long-term safety of commonly used analgesic medications in older veterans diagnosed with arthritis, 2. the effectiveness of commonly used analgesic medications in older veterans diagnosed with arthritis, 3. the factors that predict positive and negative analgesic treatment outcomes for this cohort. Methods: To accomplish these objectives we will complete two projects targeting older (50+ years age) veterans with arthritis. The first study will prospectively survey older veterans with arthritis recruited from primary care clinics at four different VA centers with geographic and prescribing pattern diversity. Prospective data collection will allow us to address limitations identified with retrospective data use. These include collecting data on current pain levels, over the counter analgesic use, functional scores (including cognitive function), and health behavior factors (e.g., smoking). The second study use a national cohort of US veterans and replicate a controversial study comparing the safety of analgesics in a cohort of veterans with osteoarthritis. Using a longitudinal cohort of veterans from 2010-2014, the comparative safety of NSAIDs, selective coxibs, and opioids will be determined using both propensity score-matched cohorts and instrumental variable analyses. Veterans Health Administrative data, linked to Medicare and Medicaid claims data, will allow for a robust evaluation of patient safety outcomes.