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Predictors of Improvement in Pain Intensity in Older Veterans with Chronic Pain: National Cohort Study

Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters D, Williams J, McFarland B. Predictors of Improvement in Pain Intensity in Older Veterans with Chronic Pain: National Cohort Study. [Abstract]. Pain. 2016 Apr 26; 17(4):S87-S87.




Abstract:

Although older adults are at high risk for pain, little is known about the factors associated with pain-related outcomes in this age group. The purpose of this study was to identify patient factors associated with improvements in pain intensity scores over time in a national cohort of older veterans with chronic pain. Using Department of Veterans Affairs (VA) administrative data, we identified 12,924 veterans with persistently elevated numeric rating scale (NRS) scores in 2010 who had not been prescribed opioids in the prior 12 months. We used two analytic approaches to examine 1) percentage decrease over 12 months in average pain scores relative to average baseline pain score; and 2) time to sustained improvement in average pain scores, defined as a 30% reduction in 3-month scores compared to baseline. Average relative improvement in pain scores from baseline ranged from 23% to 28%, and almost two-thirds of the sample met criteria for sustained improvement at some point during 12 months of follow-up. In multivariable models, older age and higher baseline pain intensity were associated with greater likelihood of improvement in pain intensity, while VA service connected disability status, mental health, and certain pain-related diagnoses were associated with lower likelihood of improvement. Opioid prescription initiation during follow-up was associated with lower likelihood of sustained improvement within subjects. Although the observational nature of the study precludes determinations regarding causality, the study supports that, on average, older adults who initiate opioids are not likely to demonstrate improvements in pain intensity over time. The findings call for 1) further analyses that adjust for opioid treatment selection bias and receipt of other pain treatments, and that identify patient groups more or less likely to show improvements over time, and 2) development of interventions that identify and target older individuals at risk for treatment refractory chronic pain.





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