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Long-Term Effects of Analgesics in a Population of Elderly Nursing Home Residents With Persistent Nonmalignant Pain

¹ Beth Israel Deaconess Medical Center, Gerontology Division and Harvard Medical School Division on Aging, Boston, Massachusetts.
² Center for Gerontology and Health Care Research, Brown University and Department of Community Health, Brown University Medical School, Providence, Rhode Island.
³ Janssen Pharmaceutica, Inc., Titusville, New Jersey.
⁴ Hebrew Rehabilitation Center for Aged, Boston, Massachusetts.

Address correspondence to Aida B. Won, MD, Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB 1A, Boston, MA. E-mail: awon{at}caregroup.harvard.edu

Background. Little is known about the long-term effects of analgesics on functional status and well-being of nursing home residents with chronic pain.

Methods. Using the Minimum Data Set, we performed a longitudinal study of nursing home residents (n = 10,372) with persistent pain. Using propensity score adjustment techniques, we compared the effect of different analgesics on changes in physical, cognitive, emotional, and social functioning, and examined rates of adverse events over a 6-month period.

Results. There was no change in the analgesic class for at least 6 months for 35.4% of residents, including 40% who received no analgesics during this time. Use of nonopioids was 37.9%, short-acting opioids was 18.9%, and long-acting opioids was 3.3%. We found improvement in functional status (adjusted hazard ratio = 1.85; 95% confidence interval [CI], 1.05–3.23) and social engagement (adjusted hazard ratio = 1.58; 95%, CI, 0.99–2.50) with long-acting opioids compared with short-acting opioids. There were no changes in cognitive status or mood status, or increased risk of depression with use of any analgesics, including opioids. There was a trend toward a lower risk of falls with use of any analgesics (adjusted odds ratio = 0.87; 95% CI, 0.70–1.06). Rates of other adverse events (i.e., constipation, delirium, dehydration, pneumonia) were not found to be higher among chronic opioid users compared to those taking no analgesics or nonopioids.

Conclusions. The use of long-acting opioids may be a relatively safe option in the management of persistent nonmalignant pain in the nursing home population, yielding benefits in functional status and social engagement.