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BMC Public Health
Published in: BMC Public Health 1/2021

Open Access 01-12-2021 | Paracetamol | Research article

Analgesic purchases among older adults – a population-based study

Authors: Maiju K. Marttinen, Hannu Kautiainen, Maija Haanpää, Heini Pohjankoski, Jukka Hintikka, Markku J. Kauppi

Published in: BMC Public Health | Issue 1/2021

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Abstract

Background

Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting.

Methods

One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases.

Results

Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain.

Discussion

Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.
Literature
1.
2.
3.
4.
Veal FC, Bereznicki LR, Thompson AJ, Peterson GM. Pharmacological management of pain in Australian aged care facilities. Age Ageing. 2014;43(6):851–6.PubMedCrossRef
5.
6.
7.
Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42(Suppl 1):i1–57.PubMedCrossRef
8.
9.
Galicia-Castillo M. Opioids for persistent pain in older adults. Cleve Clin J Med. 2016;83(6):443–51.PubMedCrossRef
10.
Gnjidic D, Blyth FM, Le Couteur DG, Cumming RG, McLachlan AJ, Handelsman DJ, et al. Nonsteroidal anti-inflammatory drugs (NSAIDs) in older people: prescribing patterns according to pain prevalence and adherence to clinical guidelines. Pain. 2014;155(9):1814–20.PubMedCrossRef
11.
Enthoven WT, Scheele J, Bierma-Zeinstra SM, Bueving HJ, Bohnen AM, Peul WC, et al. Analgesic use in older adults with back pain: the BACE study. Pain Med. 2014;15(10):1704–14.PubMedCrossRef
12.
Modig S, Elmstahl S. Kidney function and use of nonsteroidal anti-inflammatory drugs among elderly people: a cross-sectional study on potential hazards for an at risk population. Int J Clin Pharm. 2018;40(4):870–7.PubMedPubMedCentralCrossRef
13.
Ingrasciotta Y, Sultana J, Giorgianni F, Menditto E, Scuteri A, Tari M, et al. Analgesic drug use in elderly persons: a population-based study in southern Italy. PLoS One. 2019;14(9):e0222836.PubMedPubMedCentralCrossRef
14.
Wehling M. Non-steroidal anti-inflammatory drug use in chronic pain conditions with special emphasis on the elderly and patients with relevant comorbidities: management and mitigation of risks and adverse effects. Eur J Clin Pharmacol. 2014;70(10):1159–72.PubMedCrossRef
15.
Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis. 2018;9(1):143–50.PubMedPubMedCentralCrossRef
16.
17.
O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.PubMedCrossRef
18.
Koponen MP, Bell JS, Karttunen NM, Nykanen IA, Desplenter FA, Hartikainen SA. Analgesic use and frailty among community-dwelling older people: a population-based study. Drugs Aging. 2013;30(2):129–36.PubMedCrossRef
19.
Veal FC, Bereznicki LR, Thompson AJ, Peterson GM. Use of opioid analgesics in older Australians. Pain Med. 2015;16(8):1519–27.PubMedCrossRef
20.
Rapo-Pylkko S, Haanpaa M, Liira H. Chronic pain among community-dwelling elderly: a population-based clinical study. Scand J Prim Health Care. 2016;34(2):159–64.PubMedCrossRef
21.
Manchikanti L, Atluri S, Hansen H, Benyamin RM, Falco FJ, Helm Ii S, et al. Opioids in chronic noncancer pain: have we reached a boiling point yet? Pain Physician. 2014;17(1):E1–10.PubMedCrossRef
22.
Sullivan MD, Turner JA, DiLodovico C, D'Appollonio A, Stephens K, Chan YF. Prescription opioid taper support for outpatients with chronic pain: a randomized controlled trial. J Pain. 2017;18(3):308–18.PubMedCrossRef
23.
Reid MC, Henderson CR Jr, Papaleontiou M, Amanfo L, Olkhovskaya Y, Moore AA, et al. Characteristics of older adults receiving opioids in primary care: treatment duration and outcomes. Pain Med. 2010;11(7):1063–71.PubMedCrossRef
24.
Fogelholm M, Valve R, Absetz P, Heinonen H, Uutela A, Patja K, et al. Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly. Scand J Public Health. 2006;34(6):632–40.PubMedCrossRef
25.
Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.PubMedPubMedCentralCrossRef
26.
McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31(3):247–63.PubMedCrossRef
27.
28.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95.PubMedCrossRef
29.
Yusuf HR, Croft JB, Giles WH, Anda RF, Casper ML, Caspersen CJ, et al. Leisure-time physical activity among older adults. United States, 1990. Arch Intern Med. 1996;156(12):1321–6.PubMedCrossRef
30.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; world heart federation; international atherosclerosis society; and International Association for the Study of obesity. Circulation. 2009;120(16):1640–5.PubMedCrossRef
31.
Lin JJ, Alfandre D, Moore C. Physician attitudes toward opioid prescribing for patients with persistent noncancer pain. Clin J Pain. 2007;23(9):799–803.PubMedCrossRef
32.
Majnaric LT, Wittlinger T, Stolnik D, Babic F, Bosnic Z, Rudan S. Prescribing Analgesics to Older People: A Challenge for GPs. Int J Environ Res Public Health. 2020;17(11):4017.PubMedCentralCrossRef
33.
Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225.PubMedPubMedCentralCrossRef
34.
AGS. American Geriatrics Society panel on pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–46.CrossRef
35.
Atchison JW, Herndon CM, Rusie E. NSAIDs for musculoskeletal pain management:current perspectives and novel strategies to improve safety. J Manag Care Pharm. 2013;19(9 Suppl A):S3–19.PubMed
36.
Sarganas G, Buttery AK, Zhuang W, Wolf IK, Grams D, Rosario AS, et al. Prevalence, trends, patterns and associations of analgesic use in Germany. BMC Pharmacol Toxicol. 2015;16:28.PubMedPubMedCentralCrossRef
37.
Pickering G, Marcoux M, Chapiro S, David L, Rat P, Michel M, et al. An algorithm for neuropathic pain Management in Older People. Drugs Aging. 2016;33(8):575–83.PubMedPubMedCentralCrossRef
38.
Pergolizzi JV Jr, LeQuang JA, Berger GK, Raffa RB. The basic pharmacology of opioids informs the opioid discourse about misuse and abuse: a review. Pain Ther. 2017;6(1):1–16.PubMedPubMedCentralCrossRef
39.
Steinman MA, Komaiko KD, Fung KZ, Ritchie CS. Use of opioids and other analgesics by older adults in the United States, 1999-2010. Pain Med. 2015;16(2):319–27.PubMedCrossRef
40.
Pitkala KH, Juola AL, Hosia H, Teramura-Gronblad M, Soini H, Savikko N, et al. Eight-year trends in the use of opioids, other analgesics, and psychotropic medications among institutionalized older people in Finland. J Am Med Dir Assoc. 2015;16(11):973–8.PubMedCrossRef
41.
Campbell CI, Weisner C, Leresche L, Ray GT, Saunders K, Sullivan MD, et al. Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health. 2010;100(12):2541–7.PubMedPubMedCentralCrossRef
42.
Marcum ZA, Perera S, Donohue JM, Boudreau RM, Newman AB, Ruby CM, et al. Analgesic use for knee and hip osteoarthritis in community-dwelling elders. Pain Med. 2011;12(11):1628–36.PubMedCrossRef
43.
Karp JF, Lee CW, McGovern J, Stoehr G, Chang CC, Ganguli M. Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project. Int Psychogeriatr. 2013;25(11):1801–10.PubMedPubMedCentralCrossRef
44.
Hamina A, Taipale H, Tanskanen A, Tolppanen AM, Karttunen N, Pylkkanen L, et al. Long-term use of opioids for nonmalignant pain among community-dwelling persons with and without Alzheimer disease in Finland: a nationwide register-based study. Pain. 2017;158(2):252–60.PubMedCrossRef
45.
Pokela N, Bell JS, Lihavainen K, Sulkava R, Hartikainen S. Analgesic use among community-dwelling people aged 75 years and older: a population-based interview study. Am J Geriatr Pharmacother. 2010;8(3):233–44.PubMedCrossRef
46.
Gilmartin JF, Vaatainen S, Tormalehto S, Bell JS, Lonnroos E, Salo L, et al. Depressive symptoms are associated with analgesic use in people with Alzheimer’s disease: Kuopio ALSOVA study. PLoS One. 2015;10(2):e0117926.PubMedPubMedCentralCrossRef
47.
48.
Cheserek MJ, Shi Y, Le G. Association of hyperuricemia with metabolic syndrome among university workers: sex and occupational differences. Afr Health Sci. 2018;18(4):842–51.PubMedPubMedCentralCrossRef
49.
Isomaa B, Henricsson M, Almgren P, Tuomi T, Taskinen MR, Groop L. The metabolic syndrome influences the risk of chronic complications in patients with type II diabetes. Diabetologia. 2001;44(9):1148–54.PubMedCrossRef
50.
Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34(10):2220–4.PubMedPubMedCentralCrossRef
51.
Karlsson HK, Tuominen L, Tuulari JJ, Hirvonen J, Parkkola R, Helin S, et al. Obesity is associated with decreased mu-opioid but unaltered dopamine D2 receptor availability in the brain. J Neurosci. 2015;35(9):3959–65.PubMedPubMedCentralCrossRef
52.
Henriksen G, Willoch F. Imaging of opioid receptors in the central nervous system. Brain. 2008;131(Pt 5):1171–96.PubMedCrossRef
53.
Al-Hasani R, Bruchas MR. Molecular mechanisms of opioid receptor-dependent signaling and behavior. Anesthesiology. 2011;115(6):1363–81.PubMedCrossRef
54.
Ray L, Lipton RB, Zimmerman ME, Katz MJ, Derby CA. Mechanisms of association between obesity and chronic pain in the elderly. Pain. 2011;152(1):53–9.PubMedPubMedCentralCrossRef
55.
Metadata
Title
Analgesic purchases among older adults – a population-based study
Authors
Maiju K. Marttinen
Hannu Kautiainen
Maija Haanpää
Heini Pohjankoski
Jukka Hintikka
Markku J. Kauppi
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-021-10272-3

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